0

OMERIGWE, EBI GRACE

THE INFLUENCE OF BREAST CANCER CAMPAIGNS

ON KNOWLEDGE, ATTITUDE AND PRACTICE

AMONG WOMEN IN BENUE STATE

ARTS

DEPARTMENT OF MASS COMMUNICATION

MADUFOR, CYNTHIA C.

Digitally Signed by: Content manager‟s Name

DN : CN = Webmaster‟s name

O= University of Nigeria, Nsukka

OU = Innovation Centre

1

THE INFLUENCE OF BREAST CANCER CAMPAIGNS ON

KNOWLEDGE, ATTITUDE AND PRACTICE AMONG WOMEN IN

BENUE STATE

OMERIGWE, EBI GRACE

PG/MA/10/57442

A RESEARCH PROJECT SUBMITTED TO THE DEPARTMENT OF

MASS COMMUNICATION, UNIVERSITY OF NIGERIA, NSUKKA, IN

PARTIAL FUFILMENT OF THE REQUIREMENTS FOR THE AWARD

OF MASTER OF ARTS DEGREE (M.A) IN MASS COMMUNICATION

DEPARTMENT OF MASS COMMUNICATION,

UNIVERSITY OF NIGERIA, NSUKKA

SEPTEMBER 2012

2

CERTIFICATION

We certify that this project has been read and approved as an original work submitted by

Omerigwe, Ebi Grace with registration number PG/MA/10/57442 to the Department of Mass

Communication, University of Nigeria, Nsukka, in partial fulfillment of the requirements for

the award of Master of Arts Degree (M.A) in Mass Communication.

……………………. ………… …………………………………….. ………..

DR. GREG EZEAH DATE DR. NNANYELUGO, M. OKORO DATE

(SUPERVISOR) (HEAD OF DEPARTMENT)

……………………………. ………………...

EXTERNAL EXAMINER DATE

3

DEDICATION

This research study is dedicated to God Almighty, the origin of knowledge from whom all

blessings flow and to the women folk.

4

ACKNOWLEDGEMENTS

First and foremost, I am grateful to God Almighty, who gave me strength and

inspiration, then to my supervisor, Dr. Ezeah, whose constructive criticism shaped the work a

great deal and then to the authors whose works were cited to give meaning to this study.

Also, to Mr. L.I. Anorue, whose suggestions set the pace for speed in this study. Not

forgetting, Alex Onyebuchi, who brainstormed to put me on the right track of thoughts for the

topic, and provided insight into the study and areas of focus. Thanks for being generous with

your knowledge and creative ideas. I also say thank you to Ekwe Okwudiri for suggesting

that I should delve into health communication. This has increased my personal health

interests. Also, I appreciate Dr. Udeajah, Dr. Ngwu and Dr. Okoro for being very jovial and

willing to impact knowledge to their students. And to other lecturers in the department, I say

thank you for sharing your knowledge.

A very big thank you to my parents who dimmed it fit to get me equipped with

knowledge to this level. May they reap where they have sown.

Furthermore, I appreciate my special friends, Eucheria and Maureen (Dr. Reen), and

the likes of Tochi, Orekye, Philip, Oke, Alhaji Abubakar, Ese, Onyi, Moses, Chiaha, I.g,

Mercy, Kefe, Alabo, Ifeanyi, Nonso, Aja, Okwy and all my course mates. Thanks for adding

spice to this academic period of study. My special thanks to Ekwe, for his moral and material

support. I am very happy to have met you.

I also acknowledge the support of my siblings Christy, Simon, Blessing and Patience.

Not forgetting my cousins Matthew, Sam, Felix, Joe, Ekpu, Igelle and Aemu. To my

esteemed Uncles Solomon, Steven and Austin; I say a very big thank you for being proud of

me, for standing up for me in prayers and for your great display of love.

Finally, I appreciate my special roommates and friends especially Aunty Betty, and

Aunty Ijeoma; Stella, Ijeoma and Aunty Rose. It was nice sharing in your life experiences.

Mummy Garos, Chinenye, Chioma, Chinelo and Okwy, God will be your strength and

refuge, a very present help in your time of need.

5

TABLE OF CONTENTS

Title Page…………………………………………………………………………….............0

Certification………………………………………………………………………………….1

Dedication……………………………………………………………………………............2

Acknowledgements………………………………………………………………………......3

Table of Contents…………………………………………………………………………….4

Abstract……………………………………………………………………………………....5

CHAPTER ONE: INTRODUCTION

1.1 Background of Study…………………………………………………………….6-10

1.2 Statement of Problem……………………………………………………………10-11

1.3 Objectives of the Study………………………………………………………….11-12

1.4 Research Questions………………………………………………………………….12

1.5 Significance of the Study……………………………………………………………13

1.6 Scope and Limitations of the Study…………………………………………………14

1.7 Operational definition of terms…………………………………………………...14-15

References………………………………………………………………………..16-17

CHAPTER TWO: LITERATURE REVIEW

2.1 Focus of Review……………………………………………………………………18

2.2 Breast Cancer: An Overview……………………………………………………18-21

2.3 Awareness, Knowledge and Exposure to Breast Cancer Campaigns …..………21-24

2.4 Practice of BSE, Other Screening Methods and Early Detection ……………..25-29

2.5 Theoretical Framework……………………………………………………..…..29-36

2.6 Summary of Literature……………………………………………………………...36

References………………………………………………………………………37-38

CHAPTER THREE: RESEARCH METHODOLOGY

3.1 Research Design………………………………………………………………....39

3.2 Population of Study……………………………………………………………..39-40

3.3 Sampling Size……………………………………………………………………40-43

3.4 Sampling Techniques…………………………………………………………….44-45

3.5 Measuring Instrument……………………………………………………………45

3.6 Validity and Reliability of Instrument……………………………………………46-47

3.7 Method of Data Collection and Analysis ………………………………………..48

References ……………………………………………………………………….49

CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS

4.1 Data Presentation and Analysis………………………………………………..…50-70

4.2 Discussion of Findings…………………………………………………………...71-78

References………………………………………………………………………..79

CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS

5.1 Summary…………………………………………………………………………8 0-81

5.2 Conclusion……………………………………………………………………….82-83

5.3 Recommendations………………………………………………………………..83-84

References ………………………………………………………………………..85

BIBLIOGRAPHY ……………………………………………………………………....86-90

APPENDIX ……………………………………………………………………………...91-97

6

ABSTRACT

In Nigeria, 116 out of every 100,000 women have breast cancer. On the global scene,

annual, breast cancer (BRCA) incidence rate is over 1million cases and over 411,000 deaths.

Survival rate is less than 50% in developing countries, in contrast to 90% in developed

countries. This, as studies have revealed is due to late detection and diagnosis, poor

knowledge, attitude and practice towards breast cancer (BRCA), its causes, risk factors and

screening techniques. Consequently, MTN Foundation, National Breast Cancer Coalition,

Breast Cancer Action and the Miss University Nigeria campaigners have resorted to

aggressive awareness and sensitization programmes aimed at increasing knowledge,

changing attitudes and enhancing the practice of all necessary screening procedures; since

success is highly dependent on the influence of these campaigns to increase knowledge,

change unhealthy attitudes towards BRCA prevention and treatment and enhance practice of

screening methods. Using survey, personal interviews were used to find out the extent of

awareness and exposure, knowledge level, attitude and practice of screening among women

in Benue state. The Health Believe Model and Attitude Change theory gave explanation to the

reasons for unhealthy behaviours and subsequent results. Findings revealed superficial

knowledge about BRCA causes, symptoms, Genetic testing, BSE, and CBE. Also, that attitude

is influenced by strong negative emotional and psychological beliefs. The study, therefore,

emphasized the need for preventive rather than curative measures, noting the role of breast

cancer campaigns in advancing this cause.

7

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

The entire human race is at the brink of total destruction because of the increasing

susceptibility to cancer. Statistics emanating from different health organisations and agencies

around the world indicate that there are over 16 million new cases of cancer globally. This

figure, according to World Health Organization (WHO) 2011report, is likely to double in

2020 (Chustecka, 2011p.1). Over 16 million cancer cases have been predicted to occur in

2020 with 70 percent of these cases likely to take place in developing countries with Africa

accounting for over 57 percent incidence rate and one million cases of breast cancer

(Chustecka, 2011p.1).

The International Agency for Research on Cancer (IARC) gave an estimate of over

681,000 and 512,400 new cases of cancer in 2008 alone. These figures have increased to 1.4

million cases and 714,000 deaths in 2010 (IARC Report 2010 p.3). Unfortunately, it is

projected by IARC that these numbers will double before 2030, because of the aging and

growth of the population; unhealthy behaviours associated with lack of exercises, dieting,

smoking, economic development and urbanization. According to this report, the factors

mentioned above result in different types of cancers, such as cancer of the stomach, lungs,

liver, uterus, kidney (renal cell carcinoma), blood cancer known as leukemia, sinuses and

breast cancer. Breast cancer ranks the second most prevalent of all cancers worldwide after

cancer of the lungs (World Cancer Report, 2011p.4).

Globally, there are over 1.2 million cases of breast cancer with 411,000 deaths

annually. More than 56-60 percent of these deaths occur in developing countries including

Nigeria (Akpo, Akhator & Akpo 2010 p.3). It is estimated that in every 100,000 Nigerian

women, 116 of them have breast cancer and that more than half of the number have a very

8

high generic risk status and as such are vulnerable to the disease. (American Cancer Society,

2009 p.6). In addition, Akpo, Akhator and Akpo (2010 p.4), report that a recent oncological

review of cases in Nigeria revealed that, breast cancer survival rate is less than 50 percent in

Nigeria in contrast to 90 percent in developed countries. Bhopal (2002) refers to incidence as,

the calculated risk of acquiring a new state or becoming sick within a certain period of time.

He also notes that it is a frequency of occurrence of particular events at any given time.

Despite the high incidence rate, the good news, however, is that experts believe that the high

incidences of this disease can be reduced through aggressive enlightenment campaigns.

To this end, campaigns on breast cancer have been widely organized, not just in

Benue state, but in Nigeria, Africa and the world over. Worthy of note are the step-down

workshops at state levels developed by the wives of the Governors of the 36 states of the

Federation, as a follow up on the action plan by the United Nations Population Fund (UNFPA)

in April, 2008 at the Federal Capital Territory Abuja. The need to preserve lives and ensure a

steady decrease in the level of maternal mortality resulting from breast cancer has been very

salient. Also, the pet project of the Miss University Nigeria (MUN) which was an awareness

and sensitization campaign against breast cancer was hosted in Makurdi, the Benue State

capital in December, 2010. In fact, the MTN Foundation has breast cancer screening centers

located within Teaching hospitals, Federal Medical Centers (FMCs) and state General

hospitals across Nigeria (MTN Foundation, 2011 Report).

It is however, disheartening to note that despite several awareness and sensitization

campaigns on the need for regular self examination as a preventive measure for breast cancer,

so many women are still victims of the dreaded disease. As a matter of fact, breast cancer

statistics indicate an increase, especially in developing countries that previously enjoyed a

low incidence of the disease. It, therefore, means that accessibility to campaigns, awareness

and knowledge level of risk factors, attitude towards campaigns and practices are highly

9

questionable. If women are aware and exposed to campaigns, whether or not they practice

what they are taught is a determinant of the level of success of these campaigns.

A look at these significant campaigns organized by the National Breast Cancer

Coalition, tagged "Not Just Ribbons" with emphasis on substantive issues such as genetic

discrimination, access to medical care, patient‟s rights, and anti-pollution legislation as

against undue emphasis by business men on the pink ribbons; and Breast Cancer Action's

"Think Before You Pink" campaigns, give an understanding of what influence a well

structured campaign can exert on people. (Sulik, 2010 p.366–368).

Campaigns must be structured in such a way as to accommodate factors which are

vital in the fight against breast cancer. When access to the campaigns has been ensured,

exposure at the right time and place is the next consideration after which the structuring of

the campaign messages is done. These messages are meant to be the basic units of positive

influence in the campaigns, as they will determine the knowledge level, attitude and practices

of the target audience. It is the messages that will inform the women of the factors that cause

breast cancer, the types of breast cancer, the need for self examination and early detection,

the symptoms of breast cancer, treatment for it at the early stage and so on.

A good number of people might, therefore, underestimate or overestimate their

generic risk status based on their level of awareness of the possible genetic mutations that can

result in breast cancer. People who are not aware of generic factors will not understand that if

a member of the family is diagnosed of breast cancer, every other female member stands a

risk of developing breast cancer, thus the emphasis on periodic generic testing at the hospital,

besides the prescribed self examination.

That is why Ferrandis, Andreu and Galdón (2002 p.27), citing (Sattin et al., 1985),

explain that “a family history of breast cancer is a clear risk factor for developing the disease.

In effect, women who have a first degree relative with breast cancer have a 2- to 3-fold higher

10

risk of developing the disease, while women who have both the mother and a sister with

breast cancer are 14 times more likely to develop the disease than patients without a family

history of breast cancer”.

This brings us to the efficacy of awareness in the campaign against breast cancer, with

the view that efforts at raising awareness will lead to greater knowledge and invariably lead

to earlier detection and a greater survival rate. This awareness level, however, has the

information angle where according to a Chinese proverb: “the road to health is the road to

knowledge and ignoring knowledge is sickness”. Then there is the psychological angle where

too much of awareness causes guilt, fear, anxiety, depression and negative attitudes of self

isolation in breast cancer patients; where attitude developed is largely related to knowledge

acquired from social interactions, cultural values, personal interests and societal influence.

On this note, Eagly and Chaiken (1995 p.413) see attitude as a set of mental and neutral

readiness, organized through experience, which exerts a direct or dynamic influence upon a

response to all objects, and the situation with which it is related. Olson (2002 p.240–242),

Welch (2010 p.16) and Sulik (2010 p.74, 263), therefore, explain the attitude of women,

towards increased awareness on breast cancer thus:

An emphasis on educating women about lifestyle changes that may have

a small impact on preventing breast cancer often makes women feel

guilty if they do develop breast cancer. Some women decide that their

own cancer resulted from poor diet, lack of exercise, or other modifiable

lifestyle factor, even though most cases of breast cancer are due to non-

controllable factors, like genetics or naturally occurring background

radiation. Adopting such a belief may increase their sense of being in

control of their fate. Increased awareness inadvertently increases victim

blaming. Women who resist screening, mammography or breast self-

exams are subjected to social pressure, scare tactics, guilt, and threats

from some physicians to terminate the relationship with the patient.

Similarly, the emphasis on early detection results in women blaming

themselves if their cancer is not detected at an early stage.

The right attitude for women who have been diagnosed with breast cancer and those

who are free should, therefore, be captured in the campaigns, given that several factors

11

contribute in the formation of negative or positive attitudes. Like Sunder, Adarsh and Pankaj

(2009) explain, it is right to note that, society has cultural values and interests relating to

health and health services which determine attitudes towards these services, and that these

ideologies can be inimical to survival and so need to be addressed. Some women who are not

able to adapt to societal pressures, develop negative attitudes towards medical services. But

those who are able to adapt, resort to positive actions like being consistent with screening

methods and as reports have shown, most women also resort to taking up social roles and

advocacy in their fight against breast cancer, not only because of the health benefits but as a

way of promoting their emotional recovery.

1.2 Statement of Problem

Several campaigns such as those organized by MTN Foundation, National Breast

Cancer Coalition, Breast Cancer Action and the Miss University Nigeria have been organized

in the bid to fight breast cancer, yet the current statistical data of maternal mortality resulting

from breast cancer shows an increase. Cancer of the breast has the second highest cases of

cancers annually with an incidence rate of over one million cases and is still the second

principal cause of cancer mortality among women worldwide. (World Cancer Reports

2011p.4)

Breast cancer mortality rates are higher in developing countries as a result of late

detection and diagnosis. Another reason has been identified as due to lack of knowledge

about genetic risk factors for breast cancer. Also, social factors such as lack of awareness and

lack of knowledge about the disease, suspected poor attitudes towards Breast Self

Examination (BSE), Clinical Breast Examination (CBE), Mammography and other screening

methods. These explain the fact that breast cancer is not well understood by women. And as

such, there is the need for information and enlightenment to ensure early presentation at the

12

hospital. The increased mortality rate is, also, attributable to the lack of periodic practice of

early detection methods, like mammography and the lack of screening facilities. (Akpo,

Akhator & Akpo 2010 p.3)

The MTN Foundation, National Breast Cancer Coalition, Breast Cancer Action and

the Miss University Nigeria campaigners do not seem to know whether to attribute this

increase in death rate to inefficiency in campaign message delivery or timing for target

audience in campaign slots. Also, they do not know whether to blame it on audience

members‟ predispositions towards vital instructions and teachings adopted in the breast

cancer campaigns. However, some observers believe that any campaign aimed at fighting this

deadly disease must have all it takes to increase knowledge, change attitude and enhance

practice of screening methods among the audience. According to them, except there is a

significant change in the attitude of those exposed to breast cancer campaigns, the entire

exercise will amount to futility. This is the crux of the study. This study, therefore, was aimed

at finding out the extent to which women in Benue State are exposed to breast cancer

campaigns and how these campaigns have increased their awareness and knowledge level

about breast cancer risk factors, and preventive measures.

1.3 Objectives of the Study

The major purpose of this study is to discover how breast cancer campaigns have

influenced the knowledge, attitude and practice among women in Benue State towards breast

cancer prevention, detection and treatment. Therefore, the objectives of this study are to:

1. Determine the level of awareness about campaigns on the causes of breast cancer,

prevention, early detection and treatment among women in Benue State.

2. Find out the extent to which women in Benue State are exposed to breast cancer

campaigns.

13

3. Establish whether the knowledge level of women in Benue State, on breast cancer risk

factors, prevention, early detection and treatment has increased due to their exposure

to the campaigns.

4. Find out the attitude of women in Benue State towards breast cancer campaigns on

prevention, early detection and treatment.

5. Ascertain the extent to which they practice Breast Self Examination (BSE), Clinical

Breast Examination (CBE), Mammography and Genetic testing due to their exposure

to breast cancer campaigns.

1.4 Research Questions

The following research questions were directly drawn from the objectives of the study.

1. What is the level of awareness among women in Benue State, about campaigns on the

causes, prevention, early detection and treatment of breast cancer?

2. To what extent are women in Benue State exposed to breast cancer campaigns?

3. Has the knowledge level of women in Benue State, on breast cancer risk factors,

prevention, early detection and treatment increased due to their exposure to the

campaigns?

4. What is the attitude of women in Benue State towards breast cancer campaigns on the

prevention, early detection and treatment?

5. To what extent do they practice Breast Self Examination (BSE), Clinical Breast

Examination (CBE), Mammography and Genetic testing as a result of their exposures

to breast cancer campaigns?

14

1.5 Significance of the Study

The significance of this study to the media managers, health organization and

agencies, academic community and the general society cannot be over emphasized.

Drawing from this study, media professionals who are involved in breast cancer

campaigns will know the extent to which such campaigns influence knowledge, attitude and

practice of the audience towards prevention, early detection and treatment of breast cancer.

The study emphasized the need for aggressive campaigns relative to appropriate timing,

simplicity of campaign messages and influence of the campaigns.

The Ministry of Health and other health organizations and agencies (local and

international) will equally find the outcome of this study interesting. Given the scope of this

study, current statistics were provided on the knowledge, attitude and practice level of breast

cancer preventive measures among women in Benue State. Again, statistical data on mortality

rate might stir up concerns for better promotion of knowledge on self examination and early

detection; placing emphasis on prevention rather than cure. When this is achieved, increase in

death rate would have been reduced.

The study embraced both rural and urban populations in Benue State in contrast to

other works that dwelt only on rural and uneducated women. Also, studies surveying Benue

State on breast cancer awareness and sensitization are few. This study, therefore, gave

attention to health communication in the state.

Theoretically, this study provides an academic platform for testing claims put up by

some theories on attitude and behavioural change.

Finally the study is a contribution to the academia. It will serve as a reference tool for

further studies on the topic since one of the serious problems that have been identified in the

academic community in Nigeria is limited data base in research. In mass communication,

health communication related studies have not equally received serious attention despite the

15

huge resources thrown in this area. This study will, therefore, contribute to the limited pool of

literature in health communication.

1.6 Scope and Limitations of the Study

The study covers the women in Benue State from ages 15 and above. It looks at the

influence of breast cancer campaigns on knowledge, attitude and practice among these

women. The study covers a total of 11 local government areas, randomly selected from the 23

local government areas of the state drawn from the three senatorial zones of the state.

This study is, however, restricted to opinions from the questionnaire irrespective of

different individual motives in providing responses. Also, health responses on audience

breast cancer status were based on audience self believe and examination and were not at all

certified by medical doctors that they were free or infected. So based on what they felt, they

provided answers.

The study was also limited by time available to carry out the research. The available

time was not adequate given that several other activities had to be scheduled within the same

period.

1.8 Operational Definition of Terms

Breast Cancer: a disease condition that affects the breast of women in Benue State.

Campaigns: these are media programmes that are aimed at fighting against breast cancer by

informing women in Benue State on the dangers and how it can be prevented, detected or

treated

Influence: this refers to how the campaigns are able to bring about changes in the knowledge,

attitude and practices among the women in Benue State.

16

Attitudes: the disposition of women in Benue State towards breast cancer prevention, early

detection and treatment.

Knowledge: the level of technical know-how of women in Benue State on breast cancer

campaigns .relative to prevention, early detection and treatment.

Practices: all conscious efforts by the women in Benue State to fight breast cancer through

Breast Self Examination (BSE), Clinical Breast Examination (CBE), Mammography and

Genetic testing, as a result of their exposure to breast cancer campaigns.

Benue women: all females in Benue State between ages 15 and above

17

References

Akpo, E., Akpo, M. &Akhator, A. (2010). Breast cancer knowledge and screening practices

among Nigerian medical students. Delta: Delta State University. The International

Journal of Health. 11 (2).

American Cancer Society, (2009). Breast cancer: Early detection.. Retrieved April 18th 2012

fromhttp://www.cancer.org/docroot/CRI/content/CRI_2_6x_Breast_Cancer_Early_De

tection.asp.

Bhopal, R. (2002). Concepts of epidemiology. New York: Oxford University Press

Chustecka, Z. (2011). Cancer in Africa is 'Like a Runaway Train'. Medscape Medical

News 2011 WebMD, LLC. http://www.medscape.com/viewarticle/736870

Eagly, A.& chaiken, S. (1995). Attitude strength, attitude structure and resistence to change.

In R. Petty and J. Kosnic (Eds) Attitude strength. (PP 413- 415) Mahuah NJ: Erlbaum.

Ferrandis, E. D. Andreu, Y. & Galdón, M. J. (2002). The impact of information given to

patients’ families: Breast cancer risk notification. Análise Psicológica , 1 (20): 27-34.

http://www.scielo.oces.mctes.pt/pdf/aps/v20n1/v20n1a03.pdf. Retrieved April 18th,

2012

MTN Foundation, (2011). MTN foundation commissions a series of state-of-the-art dialysis

and mammography centers around Nigeria. 28th February, 2011 - 10:18 AM

http://www.mtnonline.com/mtnfoundation/content/mtn-foundation-commissions-

series-state-art-dialysis-and-mammography-centres-around-nigeriaRetrieved April 18th 2012

Olson, J. S. (2002). Bathsheba's breast: Women, cancer and history. Baltimore: The Johns

Hopkins University Press.

Park, K. (2009). Parks textbook of preventive and social medicine (20th ed). India:

Banarsidas Bhanot Publishers.

Sunder, L., Adarsh & Pankaj (2009). Textbook of community medicine; preventive and social

medicine (2nd ed). New Delhi, India: CBS Publishers and Distributors.

Sulik, G. (2010). Pink ribbon blues: How breast cancer culture undermines women's health.

New York: Oxford University Press.

The World Cancer Report, (2011). Global cancer rates could increase by 50% to 15 million

by 2020. http://www.who.int/mediacentre/news/releases/2003/pr27/en/.

18

The International Agency for Research on Cancer, (2010). World cancer report provides

clear evidence that action on smoking, diet and infections can prevent one third of

cancers, another third can be cured. http://www.who.int/mediacentre/news/releases/2003/pr27/en/ IARC reports.

UNFPA, (2010). UNFPA in Benue State: Annual report. http://nigeria.unfpa.org/benue.html

retrieved 6th May, 2012

Welch, H. G. (2010). "The Risk of Being Too Aware". The Los Angeles Times. ISSN 0458-

3035, 20th October. Retrieved April 18th, 2012 from

http://www.latimes.com/news/opinion/commentary/la-oe-welch-mammograms-

20101020,0,2961910.story.

World Health Organization (2011). WHO statistical information system. Geneva: World

Health Organization. Retrieved April 20, 2012 from http://www.who.int/whosis.

http://www.who.int/cancer/FINAL-Advocacy-Module%206.pdf

19

CHAPTER TWO

LITERATURE REVIEW

2.1 Focus of Review

The review provided insight into what breast cancer is, the various types of breast

cancer, factors that cause breast cancer and increase the mortality rate among young and old

women. It, furthermore, emphasized the need for preventive rather than curative measures

through early detection techniques, noting the role of breast cancer campaigns in advancing

this course. The Health Belief Model (HBM) and Attitude-Change Theory gave explanation

to the reasons why women still suffer and die from this disease despite some levels of

awareness generated through campaigns. To this end the review focused on the following:

Breast Cancer : An overview

Awareness, Knowledge and Exposure to Campaigns against Breast Cancer

Breast Self Examination, Other Screening Methods and Early Detection

Review of Empirical Works

Theoretical Framework

2.2 Breast Cancer: An Over View

Breast cancer is a dreaded disease and a principal cause of cancer mortality among

women worldwide and in Nigeria. It is the most common cancer among women and some

men who are hypogonadic (men with BRCA1 and BRCA2 genetic mutations). BRCA1 and

BRCA2 are human genes that belong to a class of genes known as tumor suppressors.

Changes in BRCA1 and BRCA2 genetic cells therefore result in breast cancer (National

Cancer Institute 2009 p.2&4). Cells in the breast begin to grow uncontrollably and invade

other normal cells and tissues, spreading to various parts of the body (invasive breast cancer)

in such a way that the normal body cells and tissues are obstructed from carrying out their

20

usual functions. When this happens, the normal cells that are being obstructed from

performing normally are said to have been strangulated to death. The uncontrollable cells

develop into tissues in a collection known as malignant tumours which are fatal. The ones,

however, that grow without spreading (non invasive breast cancer) and overtaking normal

cells are called benign tumours because they are not terminal.

A review of breast biopsies in the Lagos University Teaching

Hospital showed 34 per cent of all breast biopsies done over a10-

year period to be malignant. A report from Zaria described the mean

age at presentation of breast cancer as 42 years with 30 percent

occurring in women less than 25 years of age. At University College

hospital, Ibadan, 74 percent of breast cancer patients were pre

menopausal. A ten year review of breast cancer in Eastern Nigeria

revealed that patients with breast cancer constituted 30 per cent of all

patients with breast disease and that 69% of these patients were pre-

menopausal. (Salaudeen, Akande &Musa 2009 p.2)

Reports have also shown that of all malignancies typical of affluent societies, black

people appear to be at a greater risk than whites and the whites at higher risk than Asians.

Among Nigerian women, the peak age of breast cancer presentation is about 10-15years

earlier than what is observed in Caucasian women, where it occurs between the ages of 35-45

years (World Cancer Report 2011). This as we have come to understand is due to diverse

genetic risk factors and environmental factors that may affect each woman‟s susceptibility to

the disease. Life style and dieting are other factors that have been identified with

predispositions to the disease. A wrong eating habit without exercises to burn out or break

down huge fat levels of calories, results in an overall energy imbalance in the body system

and exposes one to breast cancer related diseases and breast cancer. Also, The World Cancer

Report (2011p.8) notes that, a highly caloric diet, rich in fat, refined carbohydrates and

animal protein, combined with low physical activity, is associated with a multitude of disease

conditions, including obesity, diabetes, cardiovascular disease, arterial hypertension and

cancer. Other causative factors have been identified as including reproductive history,

genetics and radiation (especially at times of breast development).

21

Breast cancer has been known and dreaded overtime. This is because its presentation

at the initial stage is as a painless lump that may not be detected without critical examination.

Again, treatments are often surgical and most times result in death. That is why advocacy

campaigns are geared towards early detection through the provision of awareness and

knowledge on genetic risk factors and other socio cultural factors that make women

vulnerable to the disease. Campaigns also emphasize the need for positive attitude and

periodic practice of Breast self examination (BSE), Clinical Breast Examination (CBE), and

other screening practices as preventive or early detection methods. Okobia, Bunker &

Okonofua (2006 p.13-19) therefore emphasize that for women to present early at the hospital

they need to be "breast aware"; and that they must be able to recognize symptoms of breast

cancer through routine practice of practicable screening.

Late detection and diagnosis are the result of increased Breast cancer mortality rates

in developing countries. Due to late presentations at the hospital, breast cancer accounts for

23% of all cancers in women with an annual occurrence of over one million cases of the

disease and 411,000 deaths (Akpo, Akhator & Akpo 2010 p.2). This, without any form of

doubts has been the reason for aggressive campaign efforts to fight the disease as far back as

the 19th century.

Early campaigns included the "Women's Field Army", run by the

American Society for the Control of Cancer (the forerunner of the

American Cancer Society) during the 1930s and 1940s. Explicitly

using a military metaphor, they promoted early detection and

prompt medical intervention as every woman's duty in the war on

cancer. In 1952, the first peer-to-peer support group, called Reach

to Recovery, was formed. Later taken over by the American

Cancer Society, it provided post-mastectomy, in-hospital visits

from women who had survived breast cancer, who shared their

own experiences, practical advice, and emotional support, but

never medical information. This was the first program designed to

promote restoration of a feminine appearance, e.g., through

providing breast prostheses, as a goal (Sulik 2010 p.37–38).

22

It is true to observe that previous campaign efforts to fight breast cancer dwelt on curative

measures rather than preventive. That was why programme planners had options of providing

artificial body parts for those who lost their breasts to surgery. The emphasis today, however,

rests on the need for prevention and early detection through aggressive and comprehensive

campaign policies and programmes that will promote the desired knowledge, attitude and

practice among women toward prevention and screening practices.

From a global perspective, there is strong justification for focusing cancer prevention

activities particularly on two main cancer-causing factors - tobacco and diet. The World

Cancer Report (2011p.5), citing Bengoa, Director, Management of Non-communicable

disease at WHO; explains the need to continue efforts to curb infections which cause cancers.

2.3 Awareness, Knowledge and Exposure to Campaigns against Breast Cancer.

The cause of breast cancer has not been completely ascertained. As a result, it cannot

be said with all certainty what the cause of breast cancer is. However, medical prognosis has

attributed the cause to certain genetic/hereditary factors, environmental factors and life style.

From this end, it can be stated categorically that breast cancer can be prevented and that your

life is in your hand since an individual‟s actions play a vital role in making lower cancer risk

a reality. This was properly captured in a statement made by Chris & Beng (2010 p.4) citing

Marilyn Gentry, the President of the American Institute of Cancer Research.

Know that cancer can be prevented and your actions play a vital

role in making lower cancer risk a reality to you and your family.

. . there are things you can do today to reduce your risk of cancer.

Not quick but basic lifestyle and dietary changes that will mean a

lower cancer risk for life

When people know that the factors that cause breast cancer are within their control, all they

need to know is what should be done at a given time and what should not be done. For

23

instance it has been emphasized that meals rich in calories and fat, animal protein and refined

carbohydrates should be consumed with caution. This is because they can be very harmful

especially when not backed up with activities to break down energy. With this knowledge the

women are empowered. All they need to do is control the levels of fat intake and consume

healthy diets. This control however will to a large extent be determined by their perception of

susceptibility to the disease and severity, benefits and barriers that can hinder positive

behaviour.

In the same light, perceived susceptibility to the threat of breast cancer, perceived

severity, coupled with modifying factors like age, knowledge, ethnicity, sex, personality and

socioeconomic factors will determine one‟s likely hood of attitude and actions based on

perceived benefits minus perceived barriers (Stretcher & Rosenstock 1997 p.34). Similarly,

Olweus (1993), identified variables such as age, gender, geographical location and level of

education as socio-demographic factors associated with certain harmful health behaviours.

In addition, two research studies conducted in 1980 and 1982 respectively by Leathar

and Roberts (1985 p.668-670), in 1985 gave a more elaborate report on attitudes towards

screening practices and made older women its central focus. The study was titled older

women‟s attitude towards breast disease, self examination and screening facilities:

implications for communication. Using Focus Group Discussion, the study identified

appropriate strategies for communication.

The results showed that knowledge of breast disease and screening facilities was poor

and that many psychological and emotional issues inhibited self examination.

It revealed, however, that increased information about BSE, CBE is unlikely to influence

attitude and practice unless it is presented together with emotional support, provided by

setting breast screening within general health screening rather than emphasizing the single

disease through mass media channels.

24

Results also revealed that, specific beliefs about breast cancer association with breast

feeding and pills were underdeveloped and not clear, awareness that women aged over 40

were more at risk was superficial although it was generally accepted that older women were

more susceptible to cancer. More so, the terminal nature of the disease dominated their

thoughts rather than early detection. And women concluded that any lump found was bound

to be malignant. Surgery was the only method of treatment they could mention.

It therefore identified, social class, poverty, age, poor knowledge and confusion about

the symptoms and extent of the disease, as psychological and emotional issues that inhibit

screening practices

The study illustrated that negative or positive attitudes were determined by

psychological and emotional issues since the dominant attitude expressed by respondents in

the focus group discussion showed that the topic was threatening. The psychology of losing a

breast owing to late detection felt abnormal and gave the affected woman a feeling of being

incomplete. Also, pity from friends and relations and the fear of possible death from the

disease greatly hindered thoughts of practicing screening. The thought of discovering a lump

could not be withstood by many because most of them concluded that any lump found was

bound to be malignant. There was uncertainty about what to look out for. They were also

pessimistic about learning or teaching the correct procedure.

Reasons for not using screening facilities were largely unrelated to factual knowledge,

though factual information was incomplete or inadequate. Wrong attitude towards screening

is emotionally based. The fear of a negative outcome is strong enough to make women refuse

screening.

The implication for communication therefore was that using media channels alone to

advocate for screening practices would only increase anxiety unless the means to resolve it

are provided; such means as emotional support. The study recommended that screening

25

should be carried out in the context of general health screening rather than emphasizing a

single disease. Since the policy that breast screening should be practiced as a single exercise

may not be quite appropriate for older women particularly those belonging to the working

class.

In a similar light, the knowledge of age factor in higher breast cancer risk is expected

to make women devoted to periodic screening and self examinations for early detection.

However, knowledge of age as a risk factor in the development of breast cancer is not enough

to influence practice of screening but the benefits of screening and threat of late detection

without screening, is more likely to prompt adoption of screening at older age. So the link

between knowledge, attitude and practice is thick. Knowledge influences attitude and positive

attitude culminates into practice.

It is, therefore, very important that campaigns inform adequately, paying particular

attention to barriers that hinder adoption of the desired behaviour. The World Cancer Report

(2011p. 8) provides that the following diet restrictions and controlled life style will enhance

lower cancer risk. The following practices can help protect you from breast cancer:

Restrict the amount of red meat in your diet

Increase your fiber intake by eating plenty of whole grain of cereals, fruits and

vegetable

Enjoy alcohol in moderation

Plan to have your first baby before the age of 30 years.

When you have babies, breast-feed them; the longer, the better.

Go for regular screening of your breasts

Perform self-breast examination monthly and regularly

Learn all that you can about breast cancer.

26

2.4 Practice of Preventive Measures: BSE, CBE, Mammography and Genetic

Testing

There are so many things to look out for in BSE, CBE, Mammography, Genetic

testing and other screening methods. The following symptoms may suggest the onset of

breast cancer. Breast lump(s) or thickness, dimpling or puckering, unusual pain, a sore that

does not heal around the nipples, itching or rash, retracted (turned in) nipples, change of

shape or size, bloody discharge from the nipple, arms swelling or lump in the armpit (World

Cancer Report 2011p.10)

The essence of screening practices is to detect the symptoms that are not visible to the

eyes and those that cannot be detected by mere palpating of the breast. For instance,

mammography screening can detect breast lumps but might not pick out other breast diseases

like breast fibroid and cysts. In this case a breast biopsy screening test will be required to

check for other related diseases. When a lump or other abnormality is detected in the breast,

through BSE, or CBE the doctor will use many investigative techniques to arrive at a specific

diagnosis as possible. Detecting one or any of these symptoms therefore depends on women‟s

attitude towards detection and practice of screening.

The most successful advancement in the fight against cancer so far has been the early

detection of cervical cancer by cytology and of breast cancer by mammography. A recent

analysis by an International Agency for Research on Cancer (IARC) working group

concluded that under trial conditions, mammography screening may reduce breast cancer

mortality by 25-30% and that in nation-wide screening programmes a reduction by 20%

appears feasible (World Cancer Report 2011p.9)

The screening techniques available for detecting breast cancer include diagnostic

mammography, ultrasound scan, cutting-needle biopsy and open biopsy. In diagnostic

mammography, an X-ray procedure is used to detect any breast abnormalities in women. It is

27

advisable that all women should have a mammogram at least once every three years to help

them detect cancer early. Other studies prescribe an annual practice.

The ultrasound scan produces a photographic picture of soft tissues in great details. It

is used as a tool to detect lumps in the breasts. It is also widely used in gynecological

investigations. (Lagos State Ministry of Health 2009 p. 6)

Cutting-needle biopsy technique involves removing a small amount of tissue from a

lump for further investigation. Under local anesthetic a special needle is inserted into the

lump in order to withdraw a fine core of tissue from it. The open biopsy however is an

alternative to cutting-needle biopsy. This involves cutting the skin of the breast open to

remove the entire lump for further investigation. It is very appropriate for women over the

age of 30 years with an obvious breast lump to have it removed for further analysis. (Lagos

State Ministry of Health 2009 p.6)

Though cancer can be prevented, it can also be treated. This, however, depends on the

stage of presentation and the extent to which the disease has caused damage to the body. That

is why the emphasis of campaigns remains prevention. The extent to which late presentation

can destroy is fatal and cannot be overemphasized. When it is detected early before it

becomes terminal, it can be treated. The most common modes of treatment have been

identified as drugs, surgery, radiation therapy, or a combination of these modes of treatment.

(Lagos State Ministry of Health, 2009 p. 7)

For Genetic testing, looking out for mutation of Deoxyribonucleic Acid (DNA) genes

is the concern of experts since mutation is linked with development of hereditary breast and

ovarian cancer. They identify these changes and give appropriate treatments to ensure

normality. Normal cells, BRCA1 and BRCA2 help ensure the stability of the cell‟s genetic

material (DNA) and help prevent uncontrolled cell growth.

Men with these mutations also have an increased risk of breast cancer. Both men and

28

women who have harmful BRCA1 or BRCA2 mutations may be at increased risk of other

cancers. In other words, a woman who has inherited a harmful mutation in BRCA1 or

BRCA2 is about five times more likely to develop breast cancer than a woman who does not

have such a mutation. BRCA1 and BRCA2 are human genes that belong to a class of genes

known as tumor suppressors. Genetic tests are therefore available to check for BRCA1 and

BRCA2 mutations.

Several methods are available to test for breast cancer BRCA1 and BRCA2 mutations.

It has been established that most of these methods look for changes in BRCA1 and BRCA2

DNA, and changes in the proteins produced by these genes. Often times, a combination of

methods are used. (National Cancer Institute, 2009 p.14)

A blood sample is required for these tests, coupled with genetic counseling before and

after the tests. Screening methods, such as Magnetic Resonance Imaging (MRI), in women

with BRCA1 or BRCA2 mutations; Mammography, BSE, CBE can be used. (National

Cancer Institute, 2009 p.14)

It has, however, been observed that though there is a general awareness about the

disease, knowledge about the need for other preventive or early detection methods like

Genetic testing is minimal. Also people do not see the benefit of Genetic testing until more

than two family members present with the disease. Below is another review that found that

change in attitude and adoption of screening as a new behaviour was largely associated with

involvement of relations and friends in the practice or presentation of lump. This, perhaps,

explains their perception of susceptibility to the disease.

In this review of study conducted by Sule (2011 p.27-31), on the topic “Breast Cancer

Awareness and Breast Examination Practices Among Women in the Central Hospital Warri,

Delta State”, a population of women between ages 20-80 were interviewed, and the findings

revealed among other things that:

29

Breast cancer awareness was noted in 96.1% of the respondents.

43.6 % of the respondents knew breast cancer begins with a breast

lump. Self breast examination had been practiced in 45.5% of

respondents. Of this number, 83.3% of the practitioners did so at least

monthly. Clinical breast examination had been experienced in 15.6%

of the respondents. The practice of breast self examination was

significantly associated with previous breast complaints, a previous

breast procedure, previous clinical breast examination and having a

family member or acquaintance with breast cancer

The study recommended that health campaigns should be aimed at increasing the practice of

Breast Self Examination. And that training of nurses in regional centers with the art of

Clinical Breast Examination (CBE) will increase compliance of women in this useful

screening tool since less than 50% of respondents engaged in the practice of breast self

examination and the entire respondents considered CBE practice dismal.

Another review on the study: “Knowledge and Attitudes to Breast Cancer and Breast

Self Examination Among Female Undergraduates in Kwara State in Nigeria”; by Salaudeen,

Akande and Musa (2009 p.157-163), interviewed a sample population of seven hundred

people and demonstrated that majority of respondents were aware of breast cancer as a

disease entity, but that their knowledge and understanding of the disease was very low. The

study came up with the results below.

Six hundred and eighty two (97.2%) respondents had ever heard of

breast cancer. Only two hundred and fifty seven (36.7%) had good

knowledge of the cause of breast cancer among the respondents. Less

than half (45.5%) of respondents had good knowledge of symptoms of

cancer of the breast. Five hundred and twenty seven (75.3%)

respondents viewed breast cancer as a frightful disease. Five hundred

and seventy three (81.9%) respondents had heard of breast self

examination. Most respondents did not know what to look for during

breast self examination. Only 38.9% and 37.4% of respondents knew

that during breast self examination it is necessary to check the size of

the breast and colour. On the attitudes of respondents to breast self

examination, only one hundred and twenty eight (18.3%) respondents

care to seek for knowledge about breast self examination. Even

though more respondents had heard of breast self examination, only

two hundred and nine (29.8%) respondents claimed they know how to

perform it.

30

The study also showed that a good number of people are indifferent about knowing

what they should know about the disease. This in the researchers‟ view suggested that such

attitude was due to their belief that breast cancer is a rare disease and that they could never be

affected by it. According to the findings, only about 130 respondents cared to seek for or

increase their knowledge about the disease.

The study, therefore, recommended that Breast cancer awareness campaign is

necessary to improve early breast cancer detection. It also stressed the need for further studies

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.

Looking at the empirical reviews in this study, one very important fact seems

consistent in them. Levels of awareness were considerably high yet practice was grossly

inhibited. This means there is a need for campaigns to be strategically pointed towards

activating the emotional nodes of the people if attitude must change. The emotional factors

that inhibit screening practices must be duly attended to. And reasons for failure of campaign

programmes have been because the messages do not address the emotional barriers that

inhibit attitude change and practice. The Health Belief model and Attitude Theory which

form the theoretical frame work of the study, therefore, explain how these emotional factors

can be addressed to bring about change to a desirable extent.

2.5 Theoretical Framework

This study is anchored on The Health Belief Model and Attitude Change Theory.

The Health Belief Model

The Health Belief Model (HBM) is a social cognition model, developed by Irwin M.

Rosenstock in 1966. It is a health behaviour change and psychological model for studying

and promoting medical programmes of some public health services. In the 1970s and 1980s

31

the model was furthered by Becker and her colleagues. Subsequently, it was modified as late

as 1988, to accommodate emerging realities within the health community about the role that

knowledge and perceptions play in personal responsibility. Originally, the model was

designed to predict behavioural response to the treatment received by chronically ill patients,

but recently it has been used to predict more general health behaviours.

The HBM suggests that your belief in a personal threat together with

your belief in the effectiveness of the proposed behaviour will predict

the likelihood of that behaviour. The underlying concept of the

original HBM is that health behaviour is determined by Personal

beliefs or perception about a disease and the strategies available to

decrease its occurrence and that personal perception is influenced by a

whole range of intrapersonal factors affecting health behaviour.

(Taylor et. al 2007, as in Hochbaum, 1958)

Therefore, the original model had these constructs below which were subsequently

modified to explain other important issues and events that needed to be explained within the

concept of the constructs: Perceived susceptibility, Perceived severity, Perceived benefits and

Perceived barriers.

In perceived susceptibility an individual's assessment of their risk of getting the

condition, is determined by his knowledge about the risk. This, therefore, means that the

greater the perceived risk, the greater the likelihood of engaging in behaviours to decrease the

risk. Based on this perception, an individual will see the possibility of contracting breast

cancer especially males who believe it is entirely a disease condition for women while some

women will see the need for screening practices, because of the perception they have and the

knowledge that the disease can be treated if detected early. Based on this perceived

susceptibility, their attitude and practice will be informed. They will be motivated to go for

screening or not. It is expected that perception of increased susceptibility, will prompt healthy

behaviours while decreased susceptibility will increase unhealthy behaviours. However, some

people do not care about their susceptibility. They stick to unhealthy lifestyle and behaviour

32

whether or not it makes them predisposed to high breast cancer risk. (Taylor, et al 2007 p.34,

citing Maes & Louis 2003). Again, Nwana (2009), notes that certain health behaviours are

determined by one‟s sexuality and perception, of the characteristics of a particular sexuality;

given that in some parts of the world, drunkenness is synonymous to males. Also, women are

more prone to consumption of foods high in cholesterol.

In perceived severity, an individual's assessment of the seriousness of the condition

and its potential consequences is influenced by his medical information or knowledge and his

belief about the disease (Tailor et al, 2007 p.34, citing McCormick 1999). Some men might

perceive that the disease is not for men and that it is a condition associated only with females.

In this sense they do not perceive it as serious and so might not see the need for genetic

testing. However, medical sciences have identified men with BRCA1 and BRCA2 genetic

mutations with very high breast cancer risk and other cancers (National Cancer Institute,

2009 p.1).

When perceived susceptibility is combined with severity it becomes perceived

threat. The perceived threat that breast cancer cannot be treated except, detected early will

likely prompt positive attitude towards periodic screening. However, just as in perceived

susceptibility, threat does not always bring about change in attitude or practice. Some older

people will remain indifferent no matter the threat.

Also, in perceived benefits an individual's assessment of the positive consequences

of adopting the behaviour will bring about change. Also, knowing the usefulness of the new

behaviour in decreasing the risk of developing a disease will bring change. People will not

cut down on foods rich in calories, exercise or reduce intake of red meat if they do not know

the benefits they will derive from not eating it. Similarly, those who see early detection as

benefit for screening or BSE will undergo it than those who do not.

33

Again, perceived barriers refer to an individual's assessment of the influences that

facilitate or discourage adoption of the promoted behaviour. Change is a difficult thing for

some people who tend to be very resistant to new behaviours. So breaking the barriers that

hinder change is very tasking. So this is the most significant of all the constructs of the HBM

in determining behaviour change. Though the threat of breast cancer can motivate adoption of

Breast Self Examination (BSE) and other screening practices, the barriers to performing BSE

tend to exert a greater influence over practice than the threat of cancer itself. The benefits of

the new behaviour must, therefore, outweigh that of the old one for change to take place.

(Taylor et al 2007 p.33, citing Janz & Becker 1984; Champion & Menon 1997; Elingson

&Yarber 1997; Umeh & Rogan-Gibson 2001).

Shea and Remoker (2011 p.2) added two more constructs to the previous four namely:

Cues to action: instigators to readiness which include events, people and things that

move people to change their behaviour. For instance illness of a friend, family

member or even media reports etcetera (Taylor et al 2007 p.33, citing Graham 2002)

Self efficacy: belief in one‟s ability to take action to produce desired outcomes.

The concept of self efficacy was introduced by Bandura in the 1970s as task specific self-

confidence, and then other scholars took to better conceptualisations.

Taylor, et al (2007 p.34) broadened the constructs further as follows:

Expectations, which are the product/sum of perceived benefits, barriers and self-

efficacy. This may be seen as indicative of the extent to which the individual will try

to take a given action (Taylor et. al, 2007, citing Smedslund, 2000)

Cues to action: this refers to reminders or prompts to take actions consistent with an

intention, ranging from advertising to personal communications from health

professionals, family members and/or peers.

34

Demographic and socio-economic variables. These may include age, race, ethnicity

(cultural identity), education and income. These are an individual‟s personal factors

that affect whether the new behaviour is adopted.

Attitude-Change Theory

The Attitude Change Theory was developed from propaganda theories in the 1930s

during World War II (Baran & Davis 2012 p.175). The theory explains that there are pre-

existing attitudes, whether biological or psychological which have to be changed if selected

messages must have any effect on the target audience. Again, it explains that these pre-

existing attitudes are in-depth and, therefore, stand as barriers to effective penetration of

messages for desired change. Thus an intellectual and emotional strategy of communication

will influence change if properly channeled to do so. Change in evaluations and perceptions

of an individual‟s predispositions will take place if the required modification favours his

expectations, if it is tied to someone he admires, or if it is bound to be beneficial to him

(Wood, 2000 p.539).

According to Breckler and Wiggins (1992 p.407), attitude has a profound influence on

behavior. It influences the perception of objects and people‟s exposure to, and comprehension

of information. Eagly and Chaiken (1995 p.413), also view attitude from an angle of effects

and evaluation when they described attitude as a tendency or predisposition to evaluate an

object or symbol of that object in a certain way. Again, Park (2009) perceive attitude as more

or less a permanent way of behaviour acquired by social interactions. This means that, one‟s

attitude is affected by intrapersonal and inter personal factors relative to acquired knowledge.

This theory, therefore, explains three bases for attitude change, which include

compliance, identification, and internalization. These three processes demonstrate the

different levels of attitude change (Wood, 2000 p.539).

35

Compliance refers to a change in behaviour based on consequences, such as an

individual‟s hopes to gain rewards or avoid punishment from another group or person. The

individual does not necessarily experience changes in beliefs or evaluation towards an

attitude object, but he resorts to a change in behaviour due to the results he intends to get out

of his adoption of a new cognition. There is also awareness that he or she is being urged to

respond in a certain way perceived as positive (Wood, 2000 p.539).

Identification explains one‟s change of beliefs and actions in order to be similar to the

one he admires. In this case, the individual changes not because of what he intends to get

from the attitude but because it is associated with an admired one. This seems like

reinforcement theory where significant others have an influence in people‟s behaviour.

Internalization refers to adoption of an attitude due to the content of the perceived

attitude. At this level of attitude change, the individual‟s evaluation towards a perceived

attitude changes when he finds the content of the attitude to be intrinsically rewarding. The

new attitude or behaviour is consistent with the individual‟s value system, and tends to be

merged with the individual‟s existing values and beliefs. Therefore, behaviour towards some

object is a function of an individual‟s intent, which is a function of one‟s overall attitude

towards the action. The Expectancy-value theory is based on internalization of attitude

change (Wood, 2000 p.539).

When a group of people with different ways of thinking and biological make up are

made aware of a specific requirement there is bound to be obstacles in the way and manner

they receive and accept messages. So efforts must be made to achieve a unified attitude that

will favour a desired cause; and such efforts must appeal or activate the emotional nodes of

the people for positive attitude change. The war, therefore, provided a platform for the

warlords to reason that there are psychological barriers to persuasion and processes (ways

forward) that will enable a given set of messages to overcome those barriers. As such they

36

devised means of detecting these barriers to the practice of persuasive messages and assess

how effectively selected messages could overcome the barriers (Baran & Davis 2012 p. 175).

The theory identifies that existing attitudes or mental predispositions need to be

changed or channeled to a particular cause through an intellectually and emotionally binding

strategy (Baran & Davis 2012 p.175).

In the campaign against breast cancer, possible barriers to knowledge acquisition,

positive attitude and practice of campaign messages may include psychological, emotional

and physical. Psychological when women see issues with opening up to modern medicine

when they detect or observe body changes that may be harmful to their bodies and conceal

their observations due to shyness or cultural beliefs. Physical, when screening facilities are

not reachable or available, or medical specialists are limited. Emotional, when the fear of

being diagnosed of the disease overrides the need for early detection.

The campaign messages must, therefore, be structured to detect these obstacles to

effective communication and assess how effectively, selected messages can overcome them.

The strategy must appeal to the attitude of the people as this is a major determinant of

effective practice.

Baran and Davis (2012 p.184), submit the strengths and weaknesses of the attitude-

change theory as follows. On the positive note, they observe that the theory pays deep

attention to process in which messages can and cannot have effects. Again it provides insight

into influence of individual differences and group affiliations in shaping media influence.

Finally, attention to selective processes helps clarify how individuals process information.

On the negative, experimental manipulation of variables overestimates their power

and underestimates the media‟s. Also, it focuses on information in media messages, not on

more contemporary symbolic media and it uses attitude change as the only measure of effects

ignoring reinforcement and more subtle forms of media influence.

37

2.6 Summary of Literature

The review looked at breast cancer on a general perspective, explaining the types of

breast cancer, the major causes which are genetic and environmental, and reasons for the high

incidence and mortality rates. It also looked at the major preventive or screening methods

known to women and emphasized the need for prevention using these methods, or the need

for treatment as the case may be.

The review equally examined the relationship between awareness, knowledge,

attitude and practice as determinants of positive or negative influence on the formation of

one‟s health behaviour and ability to make decisions on adopting an acceptable life style.

Four empirical works related to this study were reviewed and this brought about some

relevant findings on attitude and practice of screening methods: CBE, BSE, Mammography

and Genetic testing.

The study was given a theoretical support using the Health Belief Model and Attitude

Change theory. In addition, the four constructs on which the Health Belief Model was based

were explained, and the strengths and weaknesses of the attitude change theory were also

submitted in this review.

38

References

Akpo, E. & Akpo, M. Akhator, A. (2010). Breast cancer knowledge and screening practices

among Nigerian medical students. Delta: Delta State University. The Internet Journal

of Health. 11 (2). Retrieved April 18th, 2012 from http://www.ispub.com/journal/the-

internet-journal-of-health/volume-11-number-2/breast-cancer-knowledge-and-

screening-practices-among-nigerian-medical-students.html

Baran, S. J. & Davis, D. K. (2012), Mass communication theory: Foundations, ferment,

and future. (6th ed). United States: Wadsworth Cengage Learning

Breckler, S. J. & Wiggins, E. C. (1992). On defining attitude and attitude theory: once more

with feeling. In A.R. Pratkanis, S. J. Breckler, & A. C. Greenwald (Eds), Attitude

structure and function. Hillsdale, NJ: Erlbaum. P 407

Chris, K. H T. & Beng I. (2010). Knowing your breasts. minimizing breast cancer

risk! understand risk factors, preventive measures and early detection. Malaysia.

http://www.bookoncancer.com/productDetail.php?P_Id=8

Eagly, A.& chaiken, S. (1995). Attitude strength, attitude structure and resistence to change.

In R. Petty and J. Kosnic (Eds) Attitude strength. (PP 413- 415) Mahuah NJ: Erlbaum.

Health belief model, (2012). Retrieved May 5th, 2012 from

http://en.wikipedia.org/wiki/Health_belief_model

Lagos State Ministry of Health, (2009). Breast cancer. Lagos state: Breast Cancer

Organization. http://www.brecan.org /

Leathar, D. S., & Roberts. M. M. (1985). Older women's attitudes towards breast disease,

self examination, and screening facilities: Implications for communication.

Edinburgh: Springwell House. British Medical Journal. Vol. 290. March.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1417626/pdf/bmjcred00436-0016.pdf

Loewensten, G. (2007). Affect regulation and affective forecasting. In Gross, J. J. (Ed.)

Handbook of emotion regulation (pp. 180–203). New York: Guilford. http://en.wikipedia.org/wiki/Health_belief_model

National Cancer Institute. (2009). Cancer type risk factors and possible causes, prevention

detection and diagnosis. Espanol: NCI publications.

http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA

Okobia M. N, Bunker, C. H., Okonofua F.E.,& Usifo O. (2006). Knowledge, attitude and

practice of Nigerian women towards breast cancer: a cross-sectional study. Edo state:

university of Benin. February 21, World J Surg PMCID: PMC1397833 Oncol.

doi: 10.1186/1477-7819-4-11

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1397833/ retrieved April 18th

2012

Park, K. (2009). Parks textbook of preventive and social medicine (20th ed). India:

Banarsidas Bhanot Publishers.

39

Sulik, G. (2010). Pink ribbon blues: How breast cancer culture undermines women's health.

New York: Oxford University Press. ISBN 0199740453

Salaudeen A. G., Akande T. M., Musa O. I. (2009). Knowledge and attitudes to breast

cancer and breast self examination among female undergraduates in a state in

Nigeria. Kwara state Nigeria: University of Ilorin. European Journal of Social

Sciences. 7 (3). http://www.eurojournals.com/ejss_7_3_15

Sule, E. A. (2011). Breast cancer awareness and breast examination practices among women

in a Niger delta hospital. Delta state: Wilolud Journals,

Continental J. Medical Research 5 (1) pp27 - 31, ISSN: 2141 – 4211

http://www.wiloludjournal.com

Stretcher, V., & Rosenstock, I.M. (1997). The Health Belief Model. In Glanz K., Lewis F. M.,

& Rimer B. K., (Eds). Health behaviour and health education: Theory, research and

practice. San Francisco: Jossey- Bass. PP 31-36. Retrieved on May 5th 2012

from http://www.health_belief_model.org

Shea, N., & Remoker C. (2011). The health belief model. PP 1-3.Retrieved on May 5th,

2012 http://www.Nicole_shea_and_catriona_Remoker_The_Health_Belief_Model

The World Cancer Report, (2011). Breast cancer statistics

http://canceraustralia.nbocc.org.au/breast-cancer/about-breast-cancer/breast-cancer-

statistics

Taylor, D., Bury M., Campling, N., Carter S., Garfied, S., Newbould, J., & Rennie, T.

(2007). A Review of the use of the health belief model (HBM), the theory of

reasoned action (TRA), the theory of planned behaviour (TPB) and the trans-

theoretical model (TTM) to study and predict health related behaviour change.

London: University of London. National Institute for Health and Clinical Excellence

(NIHCE). Retrieved on May 5th, 2012 from http://www.nice-

doh_draft_review_of_health_behaviour-theories.pdf

Wood, W. (2000). "Attitude Change: Persuasion and Social Influence". Annu. Rev.

Psychol 51: 539–570. Retrieved from http://en.wikipedia.org/w/index.php?title=Attitude_change&oldid=489610647

40

CHAPTER THREE

RESEARCH METHODOLOGY

3.1 Research Design

The research design considered apt for this study is survey. This is because the nature

of the study requires that the researcher solicits for audience response in order to determine

the level of awareness and knowledge level among women in Benue State about the causes of

breast cancer, prevention, early detection and treatment.

Personal interviews were, therefore, suitable to generate data which substantiated the

data from the questionnaire; while a well designed questionnaire was used to collect

quantitative data, which answered the research questions raised earlier.

Four persons were interviewed; three of them were females that fall within the

specified age range for this study, and the last was an oncologist. The questions structured for

the interview, answered the research questions substantially.

From the foregoing, it can be deduced that a research design is a laid down guide for

the researcher, with which he structures his study scientifically or systematically. It is a

strategy or blue print specifying which approach will be used for gathering and analyzing

data. (Ngwu 2011 p.62 citing Chukwuemeka 2002 p.31)

3.2 Population of the Study

The Population of the study was made-up of women in Benue State from age fifteen

and above who reside in the 23 local government areas in the State from which a

representative sample was drawn.

This population was 2,109,598 in the 23 local government areas in Benue State; who

were fifteen years and above (National Population Commission Census Report 2006).

The rationale for this selection includes the following:

41

Females within that age range have a greater susceptibility to breast cancer

They fall within the puberty stage when breast development starts,

reproductive and menopausal stages when the disease is most likely to present

They comprise of the group of people to whom the campaigns on knowledge,

attitude and practice towards screening are targeted.

3.3 Sampling Size

The percentage of the population of study to be sampled for objective analysis is the

sample size. Ngwu (2011p.51) explains that a sample is part of the entire population that is

selected for investigation. Samples are the actual elements that are observed or investigated

out of the entire elements within the Universe of study.

Using the Australian Calculator, by the National Statistical Service (NSS) the

following data were imputed and it automatically generated the sample size. According to

this formula, once the values for the following variables are provided, the calculator derives

the others. The variables supplied include:

Confidence level = 95percent

Proportion = 0.5

Population= 2,109,598

Confidence interval (standard error) = 0.05

In using the Australian calculator, it is expected that the researcher selects the

confidence level at which percentage error is estimated, enter the population size and the

proportion. The proportion is however taken to be 0.5 if left blank. It is also required that the

researcher fills in one of the confidence level, standard error, relative standard error or sample

size. Once these values are provided, the „calculate‟ button can be punched and the sample

size will be automatically generated.

42

The following explain the meaning of the variables used in the Australian calculator.

Confidence Level: This refers to the level of certainty at which the researcher estimates the

percentage error. Often times, the 95% confidence level is used.

Proportion: This shows the expected size of the population likely to have the desired

attribute sought for in the survey in a 50:50 probability rating which is one over two (½) or

50percent.

Confidence Interval: This allows that the researcher provides the desired accuracy expected

from the estimate.

Standard Error: This indicates the degree to which an estimate may differ from the actual

value derivable from a complete study.

Relative Standard Error: This is derived by comparing the ratio of standard error to the

actual estimate, expressed as a percentage.

From the Australian calculation, the minimum sample size for the study is 385. This is,

however, referred to as the basic sample size according to the National Statistical Service

(NSS); given that the basic sample size does not make provisions for eventualities that may

arise in the course of distributing the questionnaire. NSS therefore recommends the use of a

contingency in order to meet the need of enlarging the sample size to complement for the

possibility of lost copies of the questionnaire while on transit or during distribution.

Based on this, the researcher conducted an over sampling, in line with the

recommendation of some renowned scholars like Bertlett, Kotrlik and Higgins (2001 p.46),

citing Salkind (1997 p.107), Fink (1995 p.36) and Cochran (1977 p.396). In their opinion, the

sample size should be increased by 40% - 50% to account for „uncooperative subjects‟. Here,

the researcher is expected to estimate the anticipated response rate in percentage and divide

the basic sample size by that response rate.

Presented below is the calculation for contingency by Bertlett, Kotrlik and

43

Higgins (2001 p.46)

n2 = Minimum sample size

Anticipated response rate

Where anticipated return rate = 95%.

Where n2 = sample size adjusted for response rate.

Where minimum sample size = 385.

Therefore:

Minimum sample size 385

n2 = Anticipated response rate = 95%

n2 = 385/0.95 = 405.2632

The sample size for the study is therefore 405.

3.4 Sampling Techniques

The probability sampling technique was employed in the study, with particular

reference to the multi stage sampling technique. This technique requires that at each stage of

sampling, two or more techniques can be employed. Thus two major techniques were

employed: the cluster sampling and the simple random sampling techniques. Ikponmwosa

(2006 p.143) explains that the simple random sampling technique allows an equal chance for

each member of the defined population, appropriately, represented by a sample size, to be

selected. Again, Ikponmwosa (2006 p.148), explains that in a cluster, the population is

subdivided into defined segments in order to reduce it to such a size as would permit a

realistic and adequate representation of the population while reducing the cost of the research.

In this study, a cluster already exists from the three senatorial zones of the state. From

the three senatorial zones A, B and C, where there are 7, 7 and 9 Local Government Areas

(LGA) respectively, the researcher selected randomly, three LGAs each from zones A

(Vandeikya, Katsina-Ala, Kwande) and B (Gboko, Buruku and Makurdi); and 5 LGAs from

44

zone C (Ado, Otukpo, Apa, Ogbadigbo and Okpokwu). So from a total of eleven LGAs, the

copies of the questionnaire were distributed.

The copies of the questionnaire per zone were arrived at by dividing the number of

LGAs in each zone by the total number of LGAs in the state, multiplied by the sample size.

The copies of the questionnaire per zone were eventually divided by the number of randomly

selected LGAs of each zone. So, the six LGAs from zones A and B had 41 copies of the

questionnaire each, since 123.26 copies were the allocation for zones A and B each. The

5LGAs in zone C however had 31.70 copies of the questionnaire each, since 158.48 copies

were meant for the zone.

Table of Zones, LGA/Population and Copies of Questionnaire per Zone

ZONES LGAs POPULATION COPIES OF

QUESTIONNAIRE

PER

ZONE

ZONE A(NE) KATSINA-ALA 111378 7/23 X405=123.26

KONSHISHA 112300

KWANDE 123200

LOGO 83501

UKUUM 108255

USHONGO 95873

VANDEIKYA 117118

ZONE B (NW) BURUKU 102560 7/23 X405=123.26

GBOKO 180656

GUMA 96846

GWER WEST 60549

GWER EAST 83373

MAKURDI 146239

TARKA 39497

ZONE C (BS) ADO 92022 9/23 X405=158.48

AGATU 57119

APA 48122

OBI 49564

OJU 84271

OTUKPO 129799

OGBADIGBO 66141

OKPOKWU 86403

OHIMINI 34812

TOTAL 23 LGAs 2109598 405

SOURCE: NATIONAL POPULATION COMMISSION CENSUS REPORT 2006

45

3.5 Measuring Instrument

The questionnaire was carefully designed to accommodate the major variables in the

study; the variables being breast cancer campaigns, knowledge, attitude and practice.

Personal interviews were also used to substantiate the responses gathered from the

questionnaire

These were used as the measuring instruments and measurements ranged from access

to campaigns, awareness of breast cancer campaigns, to knowledge of breast cancer,

causative factors and screening practices as preventive measures.

3.8 Validity and Reliability of Instrument

The expected results tallied with previous empirical works. The questions were

structured to elicit response and make the analysis of data objective. Answers that were not

very well expressed on paper were covered for adequately by responses from the personal

interview. However, face validity technique was done to ensure the validity of the

questionnaire and interview questions. The instruments were given to the project supervisor

and some lecturers in the Department of Mass Communication, University of Nigeria Nsukka,

before distribution.

The concept of reliability is crucial in any study and even more crucial depending on

the research design selected. This is because, if a survey study is to be objective, its measures

and procedures must be reliable. Reliability is arrived at when repeated measurement of the

same material results in similar decisions or conclusions (Wimmer & Dominic 2011p.170).

Based on this a test-re-test was done as, the questionnaire was administered to 24

respondents twice at an interval of one week in a pilot study after they had been validated and

the data collected at both intervals were compared to see if they met the expected reliability

rate. Anaekwe (2002), explains that test-re-test method involves administering one test to the

same group of people on two different occasions and the two scores obtained, used to

46

compute a correlation co-efficient, which is interpreted as an estimate of reliability. The

formula for calculating reliability by Pearson is given below.

r= N∑XY - ∑X∑Y

-----------------------------------------

√N∑X2 – (∑X)

2 √N∑Y

2 – (∑Y)

2

Where X refers to the frequency figure on variable X, Y is a frequency figure on

variable Y and N is the number of subjects measured on both variables.

Table for Computing Correlation Coefficient

Number of

scale

measurement

Practice of screening

methods(test 1 )

X

Practice of screening

methods (test 2)

Y

(XY)

(N) (X) X2 (Y) Y

2 (XY)

01 10 100 9 81 90

02 6 36 6 36 36

03 8 64 9 81 72

Total 24 200 24 198 198

From the table above, N= 3, ∑X=24, ∑Y= 24, ∑XY= 198, ∑X2= 200,

∑Y2=198, (∑X)

2=576, (∑Y)

2=576

Computation:

r= N∑XY - ∑X∑Y

-----------------------------------------

√N∑X2 – (∑X)

2 √N∑Y

2 – (∑Y)

2

r= 3(198) – (24) (24)

-------------------------------------------

√3 (200) – 576 √3 (198) – 576

r= 594 – 576

------------------------------------

√600 – 576 √594 - 576

r= 18

----------------------

√24 √18

47

r= 18

---------------------

4.9 x 4.2

r= 18

------------------- = 0.87

20.58

In Osuala‟s opinion (2005p.149), a high correlation coefficient indicates high

reliability of measuring instrument. For this study, the reliability correlation co-efficient, of

the questionnaire, showed 0.87, so the instrument is considered reliable.

3.6 Method of Data Collection and Analysis

A self-administered questionnaire was developed and personal interviews were

conducted. Data were collected primarily from the respondents through the responses

provided on the questionnaire and the interview sessions. The instrument contained a total of

31 questions, consisting of structured questions on breast cancer awareness and knowledge,

screening practices and other descriptive characteristics. The descriptive characteristics

included age, religion, level of education, and occupation. The questions on breast cancer

knowledge and screening practices as well as those for descriptive characteristics consisted of

selected response items such as yes/no, don‟t know, and constructed response items. Results

were tabulated.

Data were analyzed using frequency distribution tables and simple percentages in a

descriptive analysis, to examine the characteristics of the population and correct responses to

questions on breast cancer, early detection by screening methods and prevention through

genetic testing and other screening methods. Also to examine their attitude and practices

towards prevention through the clinical techniques mentioned above and through others like

dietary control.

48

References

Bertlett, J. Kotrlik, J. & Higgins, C. (2001). Organisational research: Determining

appropriate sample size in survey research. Information Technology, Learning and

Performance Journal. 19 (1) pp.43-50

Chukwuemeka, E. O. (2002). Research methods and thesis writing: A multi- disciplinary

approach. Obiagu Enugu: Hope- Rising Ventures Publishers.

Ikponmwosa, O. (2006). Fundamentals of statistics in education and the social sciences.(3rd

ed) lagos, Accra: National book consortium

National Statistical Service, (2012). Australian calculator. Retrieved 6th May, 2012

from http://www.nss.gov.au/nss/home.nsf/NSS/0A4A642C712719DCCA2571AB00

243DC6?opendocument

National Population Commission, (2006). Census report. UNFPA in Benue State: Annual

report. http://nigeria.unfpa.org/benue.html. Retrieved 6th May, 2012

Ngwu, C. S. (2011). Nigerian newspapers coverage of the 78 days presidential vacuum

crisis under late President Umaru Musa Yar’adua: A study of the Daily sun,

Guardian, The Nation and Vanguard newspapers. Unpublished thesis Enugu State

University of Science and Technology, (ESUT), Enugu.

Nwodu, C. L. (2006). Research in communication and other behavioural sciences: Principles

methods and issues. Enugu: Rhyce Kerex publications

Osuala, E. C. (2005). Introduction to research methodology (3rd

ed.). Onitsha:

Africana-First Publishers Limited.

Wimmer, R. D. & Dominic, J. R. (2011). Mass media research: An introduction. (9th ed),

Wadsworth: Cengage

49

CHAPTER FOUR

DATA PRESENTATION AND ANALYSIS

4.1 Data Presentation and Analysis

The researcher sampled a total of 405 respondents; using simple percentages and

tables for data analysis. The questionnaire had a total of 31 questions consisting of

descriptive data and structured questions on breast cancer awareness and knowledge, attitude

and screening practices.

The following tables were used to analyze data generated from the questionnaire and

interview sessions.

Demographic Information

Table 1: Sex Distribution

Sex

Distribution

No. of

Respondents Percentage

Males 0 0%

Females 404 100%

Total 405 100%

Field survey 2012

Data in table one, show that none of the respondents was a male and 405 respondents

representing 100% were females. This is because the disease condition is rare amongst males

and more predominant among females.

Table 2: Occupation

Occupation

No. of

Respondents Percentage

Civil servants 81 20%

Business 58 14.3%

Students 203 50.1%

Any other 63 15.6%

Total 405 100%

Field survey 2012

Data in table 2 indicate that 81 or (20%) of the respondents were civil servants, 58 or

(14.3%) business women, 203 or (50.1%) were students and 63 or (15.6%) specified that they

50

were applicants and unemployed people. This data provided information on the level of

activity or involvement among women and how this might be a factor in attending clinical

breast examination (CBE) or carrying out breast self examination (BSE).

Table 3: Educational Qualification

Educational

Qualification

No. of

Respondents Percentage

None 63 15.6%

SSC 150 37%

Diploma 60 14.8%

B.A /B.Sc. 70 17.3%

M.A./M.Sc. 62 15.3%

Total 405 100%

Field survey 2012

Table 3 reveals that 63 respondents representing 15.6% of the total number of

respondents, do not have any form of educational qualification, 150 or (37%) have SSC

educational qualification, 60 respondents or (14.8%) have diploma qualification, 70

respondents or (17.3%) either have a B.A or B.Sc. and 62 respondents or (15.3%) are second

degree (M.A/M.Sc.) holders.

This reveals the fact that, education is not a barrier to their access to information on

breast cancer; as most of the respondents have had some levels of educational training. Thus

they can get information if they want to.

Table 4: Breast cancer status

Status

No. of

Respondents Percentage

Free 405 100%

Infected 0 0%

Total 405 100%

Field survey 2012

As presented in the table 4 above, the total number of respondents 405 or (100%)

sampled are not infected with the disease. This result, however, lacks authenticity from

medical diagnosis as their response is based on their personal body assessment and belief.

51

Table 5: Age Distribution

Age

distribution

No. of

Respondents Percentage

15-25 203 50.1%

26-36 70 17.3%

37-47 102 25.2%

48 and above 30 7.4%

Total 405 100%

Field survey 2012

This result shows that 203 or (50.1%) of the respondents were in the age bracket of

15- 25, 70 or (17.3%) of the respondents in the range of 26-36, 102 or (25.2%) fall within the

range of 37- 47 and 30 respondents or (7.4%) within range 48 and above.

This age representation tallies with the researcher‟s target age group which is 15 years

and above. People within these ranges, fall within the breast development stage, puberty and

menopausal stages when susceptibility to breast cancer is relatively high.

Awareness and Knowledge about Breast Cancer

Table 6: Awareness of breast cancer campaigns

Awareness

No. of

Respondents Percentage

Yes 300 74.1%

No 45 11.1%

Not sure 60 14.8%

Total 405 100%

Field survey 2012

The data as presented above explain that 300 or (74.1%) respondents were aware of

sensitization campaigns about breast cancer, 45 or (11.1%) respondents said they were not

aware of the campaigns while 60 or 14.8%) of the respondents said they were not sure

whether or not there were campaigns against breast cancer. This data indicate that, awareness

level about breast cancer campaigns is relatively high.

52

Table 7: Exposure to breast cancer campaigns

Exposure

No. of

Respondents Percentage

Yes 250 62%

No 100 24%

Not sure 55 14%

Total 405 100%

Field survey 2012

Table seven shows that 250 or (62%) of the respondents were exposed to breast

cancer campaigns, 100 or (24%) were not exposed while 55 or (14%) of the respondents were

not sure of their exposure to the campaigns. This data explain that awareness about campaign

programmes does not guarantee exposure to the programmes as people tend to be selective on

whether or not to participate in the programmes.

Table 8: Source of Information about Breast Cancer

Information source

No. of

Respondents Percentage

Friends/Street van shows 40 10%

Relations 62 15%

Media 223 55%

Doctors/Seminars 80 20%

Total 405 100%

Field survey 2012

From the above table, data can be represented as follows: that 40 respondents

representing 10% of the total number sampled referred to friends and street van shows as

their sources of breast cancer information, 62 or (15%) of the respondents said their relations

are their sources, 223 or (55%) named the media- print/electronic as their sources of

information and 80 or (20%) said medical doctors and medical seminars on the subject were

their sources of breast cancer information. This suggests that campaigns through the media

are not the only sources of information, even though they are the major sources.

53

Table 9: Aim of the campaigns

Aim of the

campaigns

No. of

Respondents Percentage

Early detection 70 17.3%

Prevention 155 38.3%

All of the above 180 44.4%

Total 405 100%

Field survey 2012

Table nine shows that 70 respondents or (17.3%) saw early detection as the sole aim

of breast cancer campaigns, 155 or (38.3%) of the respondents said prevention is the aim of

the campaigns while 180 or (44.4%) of the respondents said both prevention and early

detection cannot be separated as campaigns were aimed at achieving any of them. From the

above, some people emphasized prevention through avoidable actions while others placed

value on early detection. Whatever be the case, early detection remains the chief determinant

of a successful treatment

Table 10: Knowledge about breast cancer

Knowledge about breast cancer

No. of

Respondents Percentage

A breast disease that kills 284 70%

It can be treated if detected early 61 15%

It presents as a painless lump 40 10%

It is an uncontrolled growth of cells in the breast 20 5%

Total 405 100%

Field survey 2012

From table ten, we can state that 284 or (70%) respondents know that breast cancer is

a disease that kills; 61 or (15%) know that it can be treated if detected early, 40 or (10%)

know that it presents as a painless lump and 20 or (5%) know that it is an uncontrolled

growth of cells in the breast. This is an indication that, knowledge about breast cancer as a

disease condition is relatively high.

54

Table 11: Treatable Stage of Breast Cancer

Treatable stage of

breast cancer

No. of

Respondents Percentage

Early 284 70%

Middle - -

Late - -

Don‟t know 121 30%

Total 405 100%

Field survey 2012

The above table presents that, 284 or (70%) of the respondents know that breast

cancer (BRCA) can only be treated at its initial or early stage, while 121 or (30%) do not

know the stage at which BRCA can be treated. This is why the need for campaigns to

emphasize early detection in all screening procedures is important. This agrees with

information provided by the Lagos State Ministry of Health, (2009) that, though, cancer can

be prevented it can also be treated depending on the stage of its presentation (invasive or non

invasive stage), and the extent to which the disease has caused damage to the body. The

extent to which late presentation at the hospital can destroy is fatal and cannot be

overemphasized. When it is detected early before it becomes terminal, it can be treated using

the most common modes of treatment which have been identified as drugs, surgery, radiation

therapy, or a combination of these modes of treatment.

Table 12: Knowledge of Early Stage

Knowledge of early stage

No. of

Respondents Percentage

Shortly before symptoms become obvious 284 70%

Much later - -

When condition can no longer be treated - -

Don‟t know 121 30%

Total 405 100%

Field survey 2012

Data here show that, 284 or (70%) of the respondents know that before symptoms

become obvious, breast cancer stage is early and should be given appropriate treatment while

121 or (30%) respondents do not know when to say it is early or late. This data emphasizes

55

the need to enhance in-depth knowledge among women to ensure their safety.

Table 13: Relevance of Genetic Test

Need for genetic

test

No. of

Respondents Percentage

Yes 162 40%

No 81 20%

Not sure 162 40%

Total 405 100%

Field survey 2012

Data here represent that, 162 or (40%) of the respondents said „yes‟ to genetic test, 81

or (20%) said „no‟ and 162 or (40%), said they were not sure that genetic test should be done.

This shows that knowledge about genetic test is low; as a result most of the respondents

seemed indifferent about it. Also, it has not been ascertained that genetic testing is attainable

in Nigeria. However, it is important to note that a woman, who has inherited a harmful

mutation in BRCA1 or BRCA2 Deoxyribonucleic Acid (DNA), is about five times more

likely to develop breast cancer than a woman who does not have such a mutation. BRCA1

and BRCA2 are human genes that belong to a class of genes known as tumor suppressors.

Genetic tests are, therefore, available to check for BRCA1 and BRCA2 mutations (National

Cancer Institute, 2009 p.14)

Table 14: Knowledge of genetic factors as causative of BRCA

Knowledge of

genetic factors as

causative of BRCA

No. of

Respondents Percentage

Yes 162 40%

No - -

Not sure 243 60%

Total 405 100%

Field survey 2012

Again, table 14 indicates that 162 or (40%) of the respondents were knowledgeable

about genetic factors being causative of BRCA while 243 or (60%) were not sure whether or

not BRCA is caused by genetic factors. This explains the reason why most of the respondents

56

did not appreciate the need for genetic testing. The saying that knowledge is power is,

therefore, an understatement.

Table 15: Dieting/Nutrition, Breast Cancer Causative Factor

Dieting/nutrition,

BRCA causative

factor

No. of

Respondents Percentage

Yes 365 90%

No - -

Not sure 40 10%

Total 405 100%

Field survey 2012

From table 15, it is quite obvious that 365 or (90%) of the respondents said „yes‟ to

diet as a causative factor of BRCA and 40 respondents representing 10% of the respondents

said they were not sure of dieting being a cause of BRCA. This data indicate uncertainty

about the causes of the disease condition. This is an aspect that is, also, not known to medical

practitioners. As a result they simply restrain it to genetic and environmental causes.

Table 16: Control of Intake of Calories or Excess Fat in Diet

Control of intake of calories

No. of

Respondents Percentage

Reduced consumption of foods high in calories 90 22%

Reduced consumption of white flours 94 23%

High intake of vegetables 72 18%

Regular exercises 68 17%

Nothing 81 20%

Total 405 100%

Field survey 2012

Data from table 16 provides that 90 of the respondents or (22%) control intake of

calories by reducing the consumption of foods high in calories, 94 or (23%) reduce their

consumption of white flours, 72 or (18%) of the respondents consume high amounts of

vegetables instead, 68 or (17%) engage in regular exercises while 81 or (20%) do nothing to

control intake of calories. This data prove that despite some levels of knowledge and

awareness that consumption of foods high in calories is unhealthy; some group of people will

57

not make efforts to adopt healthy nutritional values. This is in contrast with the health belief

model where individuals adopt certain health behaviours based on perceived benefits that can

be derived from such new behaviours. Here perceived benefits do not stimulate attitude

change or adoption of a new health behaviour. In line with this, Olatunde (1979) opined that

perceived benefits and perception of admirable characteristics or health attitude in significant

others and oneself influences negative or positive health behaviours and attitudes. For

example the perception of one‟s self as possessing strong immunity against infections could

encourage negative health attitudes and behaviours

Table 17: Underestimation of Risks Status

Underestimating

risks status

No. of

Respondents Percentage

Yes 284 70%

No 40 10%

Not sure 81 20%

Total 405 100%

Field survey 2012

From the table above, 284 or (70%) of the respondents said that there were people

who underestimated their risk status, 40 or (10%) said „no‟, people did not underestimate

their risk status and 81 or (20%) of them said, they were not sure whether or not people

underestimated their risk status. It is, however, true that the level of knowledge of the cause

of BRCA can make people underestimate their risks status. There are people who do not feel

threatened even with the increasing knowledge of susceptibility resulting from genetic factors.

Such people seem to have certain belief that hinge on the fact that they cannot be infected.

Table 18: Over Estimation of Risks Status

Over estimating

risks status

No. of

Respondents Percentage

Yes 365 90%

No - -

Not sure 40 10%

Total 405 100%

Field survey 2012

58

From the table above, it can be interpreted that 365 or (90%) of the respondents said

that there were people who overestimated their risks status while 40 or (10%) of them said

they were not sure if people overestimated their risk status. This result, therefore, agrees with

the opinion by Olson (2002 p.240–242); Welch (2010 p.16); and Sulik (2010 p.74, 263) that

too much of awareness causes guilt, fear, anxiety, depression and negative attitudes of self

isolation in breast cancer patients. This implies that too much of awareness and knowledge

about breast cancer and the threat of susceptibility will agitate people to overestimate their

risks status

Table 19: Other Causes of Breast Cancer

Other causes of BRCA

No. of

Respondents Percentage

BRCA related infections (breast fibroid and cyst) 101 25%

Money or phone in the bra/exposure to radiation during

breast development 41 10%

Don‟t know 263 65%

Total 405 100%

Field survey 2012

In this table, 101 or (25%) of the respondents named BRCA related infections as other

causes of BRCA, 41 or (10%) named money or phone in the bra and exposure to radiation

during breast development as a factor that causes BRCA, while 263 or (65% ) said they did

not know other causes of BRCA. According to The World Cancer Report (2011p.8), a highly

caloric diet, rich in fat, refined carbohydrates and animal protein, combined with low physical

activity, is associated with a multitude of disease conditions, including obesity, diabetes,

cardiovascular disease, arterial hypertension and breast cancer. Other causative factors have

been identified as including reproductive history, genetics and radiation (especially at times

of breast development).

59

Table 20: Symptoms of Breast Cancer

Symptoms of BRCA

No. of

Respondents Percentage

Lumps, pains, swelling 300 74%

Reddening of nipples/dimpling 40 10%

Don‟t know 65 16%

Total 405 100%

Field survey 2012

Data here show that 300 or (74%) of the respondents know that BRCA presents as

lumps, pains and swelling, 40 or (10%) of them said it presents as reddening of nipples and

dimpling of the breast while 65 or (16%) of them said they did not know the symptoms of

BRCA presentation. This implies, therefore, that not every female knows how BRCA

presents itself. However, the following symptoms may suggest the onset of breast cancer.

Breast lump(s) or thickness, dimpling or puckering, unusual pain, a sore that does not heal

around the nipples, itching or rash, retracted (turned in) nipples, change of shape or size,

bloody discharge from the nipple, arms swelling or lump in the armpit (World Cancer Report

2011p.10)

Table 21: Audience Stand on Genetic Test for Hereditary Syndrome of Breast Cancer

Stand on genetic test for

hereditary syndrome of BRCA

No. of

Respondents Percentage

Yes 284 70%

No - -

Not sure 121 30%

Total 405 100%

Field survey 2012

Data from table 21 above show that, 284 or (70%) of the respondents agreed that

families that have hereditary syndrome predisposing to BRCA should go for genetic testing

while 121 or 30% of them said they were not sure whether or not such families should go for

genetic testing. However, to ease or reduce the fear of overestimating risk status and the

anxiety that every female in the family is not safe, it is wise for such families to go for

genetic testing. It will reveal risk status and may reduce the need for other forms of screening.

60

In line with the above, Ferrandis, Andreu and Galdón (2002 p.27), citing (Sattin et al.,

1985), explain that “a family history of breast cancer is a clear risk factor for developing the

disease. In effect, women who have a first degree relative with breast cancer have a 2- to 3-

fold higher risk of developing the disease, while women who have both the mother and a

sister with breast cancer are 14 times more likely to develop the disease than patients without

a family history of breast cancer”.

Table 22: Knowledge of Peak Age of Breast Cancer Presentation in Blacks

Knowledge of peak age of

BRCA presentation in blacks

No. of

Respondents Percentage

Yes 100 25%

No 150 37%

Not sure 155 38%

Total 405 100%

Field survey 2012

From the above, 100 respondents representing 25% of the total number of the

respondents know the peak age of BRCA presentation in blacks, 150 or (37%) of them, did

not know and 155 or (38%) were not sure of the peak age of BRCA presentation. This

explains the fact that most females do not know the peak periods when they should expect

BRCA presentation and thus look out for symptoms thoroughly. However, reports have

shown that of all malignancies typical of affluent societies, black people appear to be at a

greater risk than whites and the whites at higher risk than Asians. Among Nigerian women,

the peak age of breast cancer presentation is about 10-15years earlier than what is observed in

Caucasian women, where it occurs between the ages of 35-45 years (World Cancer Report

2011p.8).

61

Table 23: Frequency of Visit to Health Centers for Clinical Breast Examination (CBE)

Frequency of CBE

No. of

Respondents Percentage

Often 50 12%

Very often 10 2%

Not often 75 19%

Not at all 270 67%

Total 405 100%

Field survey 2012

Figures from table 23 make it obvious that, 50 or (12%) respondents visit health

centers for CBE, 10 or (2%) very often, 75 or (19%) not often, while 270 or (67%) of the

respondents do not visit health centers at all. This is an indication of low practice rate for

CBE. Olweus (1993) identified variables such as age, gender, geographical location and level

of education as socio-demographic factors associated with certain health behaviours whether

positive or negative.

Table 24: Practice of Breast Self Examination (BSE)

Practice of BSE

No. of

Respondents Percentage

Yes 324 80%

No 81 20%

Total 405 100%

Field survey 2012

Table 24 shows that 324 or (80%) of the respondents practiced breast self

examination while 81 or (20%) did not. This shows that though a good number of females did

not visit health centers for CBE, they practiced BSE conveniently. The World Cancer Report

(2011p.10), however, emphasizes that, the essence of screening practices is to detect the

symptoms that are not visible to the eyes and those that cannot be detected by mere palpating

of the breast. For instance, mammography screening can detect breast lumps but might not

pick out other breast diseases like breast fibroid and cysts. In this case a breast biopsy

screening test will be required to check for other related diseases, after which the doctor uses

several investigative techniques to arrive at a specific diagnosis as possible.

62

Table 25: Reasons for None Practice of BSE

Reasons for none practice of BSE

No. of

Respondents Percentage

Don't believe I am susceptible to the disease 162 40%

Don't remember to examine my breast 81 20%

Do not attach importance to BSE 40 10%

Treat the issue of BRCA with levity 122 30%

Total 405 100%

Field survey 2012

Data from table 25, suggest that 162 or (40%) of the respondents did not believe that

they were susceptible to the disease, 81 or (20%) of them did not practice BSE because they

did not remember, 40 or (10%) of the respondents did not because they did not attach

importance to BSE; 122 or (30%) of the respondents did not practice BSE out of mere levity

for the issue of BRCA or BSE. This clearly portrays some negative attitudinal barriers to the

success of BRCA campaigns. It also means that campaigns must appeal to these barriers if

success must be achieved. Results here, tally with that generated by Salaudeen, Akande and

Musa (2009 p.157-163), in their study: “Knowledge and Attitudes to Breast Cancer and

Breast Self Examination among Female Undergraduates in Kwara State in Nigeria” which

showed that a good number of people were indifferent about knowing what they should know

about the disease. This in the researchers‟ view suggested that such attitude was due to their

belief that breast cancer is a rare disease and that they could never be affected by it.

Table 26: Frequency of Practice of Breast Self Examination

Frequency of BSE

No. of

Respondents Percentage

Often 200 49%

very often 124 31%

Not often 81 20%

Total 405 100%

Field survey 2012

From this data it can be presented that 200 respondents or (49%) often practice BSE,

124 or (31%) practiced it very often, and 81 or (20%) of the respondents do not practice BSE

often. This explains that some people are not consistent with the practice of BSE due to so

63

many reasons. Leathar and Roberts (1985 p.668-670), in their two research studies conducted

in 1980 and 1982 respectively, gave a more elaborate report on attitudes towards screening

practices as they noted that some of the reasons for women‟s indifference to consistent

practice of BSE were that, the terminal nature of the disease dominated their thoughts rather

than early detection. Again, women concluded that any lump found was bound to be

malignant so, the thought of discovering a lump could not be withstood by many. They, also,

feared that surgery as a method of treatment was deadly. The researchers, therefore, identified

social class, poverty, age, poor knowledge and confusion about the symptoms and extent of

the disease, as psychological and emotional issues that inhibit screening practices.

Table 27: What to Look Out For When Conducting BSE

Focus of BSE

No. of

Respondents Percentage

Lumps, swelling and pains 300 74%

Reddening of nipples 20 5%

Dimpling of breast/ orange-like skin texture 20 5%

Not sure 65 16%

Total 405 100%

Field survey 2012

This result indicates that 300 or (74%) of the respondents looked out for lumps, pains

and swelling during BSE, 20 or (5%) of them looked out for reddening of nipples and breast

dimpling respectively, while 65 or (16%) were not sure of what to look out for. This reveals

that the most common symptoms females have knowledge about are, the presence of lumps,

swelling and pains. As such only a few of them have knowledge about reddening, dimpling

and an orange-like skin texture as symptoms of BRCA presentation.

Table 28: Ideal Period for Breast Self Examination

7-10 days AMP ideal for BSE

No. of

Respondents Percentage

Yes 305 75%

No - -

Not sure 100 25%

Total 405 100%

Field survey 2012

64

This table reveals that 305 or (75%) of the respondents said „yes‟ to 7-10days after

menstrual period as an ideal time for breast examination, 100 or (25%) of them said they

were not sure of the most suitable time for breast examination. Field surveys have shown that

some days after menstrual period is ideal to ensure that females do not confuse pains or

swelling associated with menstrual periods for BRCA symptoms

Table 29: Mammography as a Form of Early Breast Cancer Detection Technique

Stand on Mammography,

as a detection technique

No. of

Respondents Percentage

Yes 290 72%

No 65 16%

Don't know 50 12%

Total 405 100%

Field survey 2012

Results here reveal that 290 or (72%) of the respondents know that mammography is

a form of early breast cancer detection technique, 65 or (16%) of them said it was not a form

of early BRCA detection technique, and 50 or (12%) of them did not know whether or not it

was a form of early BRCA detection technique. This also emphasizes inadequate knowledge

of screening methods.

Table 30: Removal of Breast Lump Altering the Risks of Breast Cancer Recurrence

Removal of lump altering

BRCA risks

No. of

Respondents Percentage

Yes 284 70%

No 40 10%

Not sure 81 20%

Total 405 100%

Field survey 2012

Figures from the above table indicate that, 284 or (70%) of the respondents know that,

the removal of breast lump does not alter the risks of predisposition to breast cancer, 40 or

(10%) said that, it alters the risks of predisposition to BRCA while 81 or (20%) of them were

not sure whether or not removal of breast lump alters the risks of predisposition to breast

65

cancer. This also emphasizes the shallow nature of knowledge about the disease condition of

BRCA.

Table 31: Dimpling, Swelling, Redness and Lumps as signs of Breast cancer

Signs of BRCA

No. of

Respondents Percentage

Yes 340 84%

No - -

Don't know 65 16%

Total 405 100%

Field survey 2012

Field survey from table 31 above shows that, 340 or (84%) of the respondents know

the signs to look out for when palpating the breast, while 65 or (16%) of them did not know

what signs to look out for.

Interview Questions

First Segment of Interview: three females within the age bracket for this study.

Note that the text below are not the exact words of the interviewees as the texts were

paraphrased to ensure clarity, given that some of the interviewees were not familiar with

medical terminologies like breast self examination, even though they had an idea of it. Again,

one of the interviewees mixed her tenses with Pidgin English. In cases like that the researcher,

paraphrased with clearer words.

1. Number of Breast Cancer Campaigns Attended Since 2008

Exposure to campaigns Respondents

Since 2008, I have not attended any breast cancer campaigns but I stumbled

on an open van street campaign around Wadata market in June this year and

I stood by to get what they had to say. Patience

I have not attended any in Benue state since 2008 Mercy

None. Katherine

Field survey 2012

66

2. Knowledge level of BRCA risk factors, prevention, early detection and treatment due

to exposure to campaigns

Knowledge level due to exposure to campaigns Respondents

Due to my exposure to TV, newspapers and health magazines, I am kept

abreast of information about breast cancer. I also know that the major

treatment is surgery and that when lumps are detected they have to be

removed surgically too. Mercy

In my community development group, this subject was treated, coupled

with the street show I stumbled on. I also have doctor friends whom I gist

with about health issues including breast cancer. I know that there is a need

for early detection through self examination. Patience

I know about BSE, how to position my body for breast examination and

what to look out for. I got this information from a television programme

titled: „The Thrift Collector‟. Katherine

Field survey 2012

3. Knowledge of Breast Cancer

Knowledge of what BRCA is Respondents

It is a disease that affects the breast of females and it kills if not treated at an

early stage. Katherine

Is a disease condition that causes pains in the breast, lumps, swelling and

results in death if not detected early for treatment. Mercy

Breast cancer is a deadly breast disease. Patience

Field survey 2012

4. Knowledge of Screening Methods

Knowledge of screening methods

The three respondents had knowledge about Breast Self Examination (BSE) and Clinical

Breast Examination (CBE), even though they could not give it the actual name. They were

not aware of biopsy screening tests and mammography or even genetic test.

Field survey 2012

67

5. Knowledge of Ideal Frequency for Practice of BSE, CBE, Mammography and genetic

tests

Knowledge of ideal frequency for screening practice

As a result of the level of knowledge about screening methods, they could only say the ideal

periods to practice BSE and CBE; and as they rightly noted, these should be practiced

monthly and seven to ten days after menstruation to avoid confusing possible BRCA

symptoms with menstrual symptoms.

Field survey 2012

6. Relevance of Preventive Practices

Reason for Practice

Life is sacred. Women play dual roles in the family. As mothers they need to be breast

healthy for their babies and as wives they have to be healthy for their husbands and so that

they do not feel socially unaccepted due to mastectomy (entire breast removal) as the case

may result into.

Field survey 2012

Second Segment of Interview, with an Oncologist

In this segment of the interviews, a breast surgeon name with held for reasons he

would not disclose, provided answers to some of the questions raised. He works with the

Federal Medical Center in Makurdi, Benue state. He refused the recording of the interview

and said that he would prefer to be referred to as anonymous. The following are the responses

he gave. It is however important to note that the texts used were not his exact words. This is

because; the session was not recorded and then, some medical jargons had to be simplified

for better understanding.

68

Question 1: Causes of Breast Cancer

Causes of BRCA

In responding to this question, the doctor noted that there are no specific causes of BRCA

identified so far. However, he said that breast cancer (BRCA) mutations can be attributed to

basically genetic and environmental factors which can, also, be referred to as natural and

manmade. The genetic causes according to him are those that are concerned with

Deoxyribonucleic Acid (DNA) traits and how they are transferred by blood from generation

to generation. While the environmental causes are due to consumption of unhealthy diets,

like excess fats, polished carbohydrates, lack of physical exercises to enhance internal

balance, and exposure to radiation especially during early periods of breast development.

These environmental factors extend to unhealthy lifestyle, the use of cosmetics with some

harmful chemicals used in their production and so on

Field survey 2012

Question 2: Black Women and BRCA predisposition

Skin colour and predisposition to BRCA

The doctor expressed his contrary opinion to what the question actually suggests.

According to him, blacks are not more predisposed to BRCA and that there are no medical

facts to prove otherwise. He said that as a matter of fact, not until recently, statistics have

shown that blacks enjoyed a relatively low or no incidence rate of BRCA. He, therefore,

vehemently disagreed with the notion that blacks were more predisposed to BRCA.

However, some reports insist that blacks are more predisposed than whites and whites than

Asians, yet they do not provide reasons for their argument.

Field survey 2012

Question 3: Relevance of Genetic Testing

Relevance of genetic testing

It is necessary to ensure clarity of risks amongst relations and generations. Especially in

families where more than one or two first degree relations have shown obvious symptoms

or actually suffered from Breast cancer (BRCA). Though it is not yet certain that this is

obtainable anywhere in Nigeria, it is a very good idea to test for possible changes in BRCA

mutations.

Field survey 2012

69

Question 4: Breast Cancer Mortality Rate in Benue State

BRCA Mortality rate in Benue State

Generally, statistics have not provided specific figures for mortality rates in Benue state or

even Nigeria. It is however deducible from annual world reports that the estimated

incidence rate for Nigeria in 2010 and subsequent years is very high and this invariably

applies to the state too.

Field survey 2012

Question 5: Treatable Stages of Breast Cancer

Stages of BRCA

He also noted the types of breast cancer (BRCA) when he identified stages 0-IV of breast

cancer. Where zero is used to represent non-invasive breast cancer a type as he noted that

can be treated by lumpectomy which is removal of the infected tissues and a lymph node

biopsy might also be required to evaluate the state of the nodes since cancer travels fast

through them. All forms of breast cancers that have exceeded stage 0 are invasive and tend

to spread round the body. A type of invasive BRCA was identified as metastatic breast

cancer which, though, not as aggressive as the inflammatory type of invasive breast cancer,

is also deadly. He further explained that, the non-invasive BRCA develops in parts of the

breast and remain (sometimes) within that region without extending to other tissues or

regions of the body. Also, that the non-invasive types of cancers are mostly benign and can

be cured. On the other hand, the invasive cancers being that which invade a part of the body

and spread to other parts destructively cannot be cured. Finally, he emphasized that, unless

BRCA is detected at stage zero, treatment is never curable, as the disease will always have a

recurrence.

Field survey 2012

Question 6: Screening Centers in Benue State

Screening Centers in Benue State

He explained that he was not certain about the number of screening centers in the State but

identified some available at the Benue State Teaching Hospital in Makurdi, equipped by the

MTN Foundation; and others at the Federal Medical Center Api.

Field survey 2012

70

4.2 Discussion of Findings

The discussion was guided by the five research questions for the study. The following

are, therefore, answers to the research questions drawn from the objectives of the study in

chapter one. These answers were reached from the findings of the field survey research.

Research Question 1

What is the level of awareness among women in Benue State about campaigns on the

causes, prevention, early detection and treatment of breast cancer (BRCA)?

Questions six and 10 from the questionnaire were used to elicit for audience response on their

level of awareness about breast cancer campaigns.

The data as presented in table six explain that 300 or (74.1%) of the respondents were

aware of sensitization campaigns about breast cancer, 45 or (11.1%) of the respondents said

they were not aware of the campaigns while 60 or (14.8%) of the respondents said they were

not sure whether or not there were campaigns against breast cancer.

Results from table ten provide that, 284 or (70%) of the respondents were aware of

the fact that breast cancer is a disease that kills; 61 or (15%) knew that it could be treated if

detected early, 40 or (10%) were also aware that it presents as a painless lump and 20 or (5%)

knew that it is an uncontrolled growth of cells in the breast.

The findings here, therefore, indicate that awareness level about breast cancer (BRCA)

campaigns is relatively high and that, knowledge about breast cancer as a disease condition is

relatively high. In one way or the other a good number of the people have heard that BRCA is

a deadly disease condition that has to be prevented or detected early. So it is quite obvious

that the people are generally or superficially aware of the disease and the „fights‟ against it.

71

Research Question 2

To what extent are women in Benue State exposed to breast cancer campaigns?

Responses to this question came from field survey answers to questions seven and eight.

Data from table seven provide that, 50 or (12.3%) of the respondents were exposed to

breast cancer campaigns, 350 or (86.4%) were not exposed while 5 or (1.2%) of the

respondents were not sure of their exposure to the campaigns.

Evidence of exposure to campaigns was further presented as respondents provided

their sources of exposure. As seen in table eight above, 40 respondents representing 10% of

the total number sampled referred to friends and street van shows as their sources of breast

cancer information, 62 or (15%) of the respondents said their relations were their sources,

223 or (55%) named the media- print/electronic as their source of information and 80 or

(20%) said medical doctors and medical seminars were their sources of breast cancer

information.

These data provide findings that explain that awareness about campaign programmes

does not guarantee exposure to programmes but individual disposition to the programmes and

disposition to the credibility of sources. As a result, people tend to be selective of sources and

of whether or not to participate in these programmes. People, also, tend to perceive threats

and barriers to exposure differently; and depending on the direction that perception takes, the

action of exposure to campaign programmes will be defined. Findings, also, suggest that

campaigns through the media are not the only sources of information even though they are

the major sources.

Research Question 3

Has the knowledge level of women in Benue State on breast cancer (BRCA) risk

factors, prevention, early detection and treatment increased due to their exposure to the

campaigns?

72

In answering research question three above, questions nine, 11-16, 20, 22, 27-31 were

explicit about the knowledge level of women in Benue State on breast cancer risk factors,

prevention, early detection and treatment due to their exposure to the campaigns.

Table nine shows that, 70 respondents or (17.3%) saw early detection as the sole aim

of breast cancer campaigns, 155 or (38.3%) of the respondents said prevention was the aim of

the campaigns while 180 or (44.4%) of the respondents said both prevention and early

detection cannot be separated as campaigns are aimed at achieving any of them.

In table 11, 284 or (70%) of the respondents know that breast cancer (BRCA) can

only be treated at its initial or early stage, while 121 or (30%) did not know the stage at which

breast cancer can be treated. In addition to knowing that it has to be detected early some

people showed their understanding of the word early as data in table 12 show that, 284 or

(70%) of the respondents knew that before symptoms become obvious, breast cancer stage is

early and should be given appropriate treatment while 121or (30%) of the respondents did not

know when to say it is early or late.

Data from 13 above represents the fact that knowledge is superficial as genetic testing

is quite a new subject to most of the respondents. The figures indicate that only 162 or 40%

of the respondents saw the need for genetic testing, 81 or (20%) said no and 162 or (40%),

said they were not sure that genetic tests should be done.

Again, table 14 indicates that 162 or (40%) of the respondents were knowledgeable

about genetic factors being causative of breast cancer while 243 or (60%) were not sure

whether or not breast cancer was caused by genetic factors.

However, from table 15, it is quite obvious that 365 or (90%) of the respondents had

the correct knowledge of the fact that unhealthy dieting can be a causative factor of breast

cancer while 40 respondents representing 10% of the respondents said they were not sure of

dieting being a cause of breast cancer.

73

As a result of the above knowledge, data from table 16 provide that 90 of the

respondents or (22%) controlled intake of calories by reducing the consumption of foods high

in calories, 94 or (23%) reduced their consumption of white flours, 72 or (18%) of the

respondents consumed high amounts of vegetables instead, 68 or (17%) engaged in regular

exercises while 81 or (20%) did nothing to control intake of calories.

The most common symptoms known to the respondents are swelling, pains and lumps.

This is evident in data from table 20 which show that 300 or (74%) of the respondents knew

that breast cancer presents as lumps, pains and swelling, 40 or (10%) of them said it presents

as reddening of nipples and dimpling of the breast while 65 or (16%) of them said they did

not know the symptoms of breast cancer presentation.

Despite exposures to campaigns, knowledge about the peak age of breast cancer

presentation in blacks is low. From table 22, 100 respondents representing 25% of the

respondents knew the peak age of breast cancer presentation in blacks, 150 or (37%) of them,

did not know and 155 or (38%) were not sure of the peak age of breast cancer presentation.

Again, results from table 27 indicate that 300 or (74%) of the respondents looked out

for lumps, pains and swelling during BSE, 20 or (5%) of them looked out for reddening of

nipples, breast dimpling and an orange-like skin texture respectively, while 65 or (16%) are

not sure of what to look out for. In table 28, 305 or (75%) of the respondents said “yes” to 7-

10 days after menstrual period as an ideal time for breast examination, 100 or (25%) of them

said they were not sure of the most suitable time for breast examination.

Results from table 29, reveal that 290 or (72%) of the respondents knew that

mammography was a form of early breast cancer detection technique, 65 or (16%) of them

said it was not a form of early breast cancer detection technique, and 50 or (12%) of them did

not know whether or not it was a form of early breast cancer detection technique.

74

Figures from table 30 indicate that, 284 or (70%) of the respondents knew that,

removal of breast lump would not alter the risks of breast cancer recurrence, 40 or (10%) said

that, it would alter the risks of predisposition to breast cancer while 81or (20%) of them were

not sure whether or not the removal of breast lump would alter the risks of predisposition to

breast cancer.

Data from table 31show that, 340 or (84%) of the respondents knew the signs to look

out for when palpating the breast, while 65 or (16%) of them did not know what signs to look

out for.

Findings show that some people emphasize prevention through avoidable actions

while others place value on early detection. Early detection remains important as a

determinant of a successful treatment. There is the need, however, for campaigns to enhance

in-depth knowledge among women and emphasize prevention and early detection in all

screening procedures to ensure their safety.

Findings also reveal that knowledge about genetic testing is low; as a result most of

the respondents seemed indifferent about it. Also, that it has not been ascertained that genetic

testing is attainable in Nigeria. This explains the reason why most of the respondents do not

appreciate the need for genetic testing. It, therefore, means that knowledge is superficial since

genetic testing is quite a new subject to most of the respondents.

Discoveries, also, reveal uncertainty about the causes of the disease condition as an

aspect that is also not known to medical practitioners. As a result they simply restrict it to

genetic and environmental causes.

Furthermore, it was observed that despite some levels of knowledge and awareness

that consumption of foods high in calories is unhealthy; some group of people will not make

efforts to adopt healthy nutritional values. This agrees with the Health Belief Model (HBM)

that says health behaviour is determined by one‟s belief and perception about a disease and

75

the strategies available to decrease its occurrence and that personal perception is influenced

by a whole range of intrapersonal factors affecting health behaviour (Taylor et. al 2007),

citing (Hochbaum 1958). Based on the intrapersonal factors, Individuals adopt certain health

behaviours.

Additionally, observations are that not every female knows how breast cancer

presents itself. This explains why most females did not know the peak periods when they

should expect breast cancer presentation and thus look out for symptoms thoroughly.

Interestingly, the most common symptoms females have knowledge about are the

presence of lumps, swelling and pains. As such only a few of them have knowledge about

reddening, dimpling and an orange-like skin texture as symptoms of breast cancer

presentation.

Field surveys have shown that 7-10 days after menstrual period is ideal to ensure that

females do not confuse pains or swelling associated with menstrual periods for breast cancer

symptoms.

More so, findings emphasize the lack of adequate knowledge or the shallow nature of

knowledge about the disease condition of breast cancer.

Research Question 4

What is the attitude of women in Benue State towards breast cancer campaigns on the

prevention, early detection and treatment?

Responses to questions 17, 18, 19 and 21provide adequately for research question 4.

In table 17, 284 or (70%) of the respondents said that there were people who

underestimate their risk status, 40 or (10%) said that, people did not underestimate their risk

status and 81 or (20%) of them said, they were not sure whether or not people underestimated

their risk status.

76

From table 18, it can be interpreted that 365 or (90%) of the respondents said that

there were people who overestimated their risks status while 40 or (10%) of them said they

were not sure if people overestimated their risk status.

Data from table 21 above shows that, 284 or (70%) of the respondents agreed that

families that have hereditary syndrome predisposing to breast cancer should go for genetic

testing while 121 or (30%) of them said they were not sure whether or not such families

should go for genetic testing.

It was observed that the level of knowledge of the cause of breast cancer can make

people underestimate their risks status. It was also observed that there are people who do not

feel threatened even with the increasing knowledge of susceptibility resulting from genetic

factors. Such people seem to have certain beliefs hinged on the fact that they cannot be

infected.

From another angle, this result agrees with the opinion by Olson (2002: 240–242);

Welch (2010:16); and Sulik (2010: 74, 263) that too much of awareness causes guilt, fear,

anxiety, depression and negative attitudes of self isolation in breast cancer patients. This

implies that too much of awareness and knowledge about breast cancer and the threat of

susceptibility will agitate people to overestimate their risks status. However, to ease or reduce

the fear of overestimating risk status and the anxiety that every female in the family is not

safe, it is wise for such families to go for genetic testing. It will reveal risk status and may

reduce the need for screening.

Research Question 5

To what extent do they practice Breast Self Examination (BSE), Clinical Breast

Examination (CBE), Mammography and Genetic testing as a result of exposures to breast

cancer campaigns?

77

Responses to questions 23-26 provide answers to research question 5. Figures from

table 23 make it obvious that, 50 or (12%) of the respondents visit health centers for CBE, 10

or (2%) very often, 75 or (19%) not often, while 270 or (67%) of the respondents did not visit

health centers at all.

Table 24 shows that 324 or (80%) of the respondents practiced breast self

examination while 81 or (20%) did not.

Data from table 25, suggest that 162 or (40%) of the respondents did not believe that

they were susceptible to the disease, 81 or (20%) of them did not practice BSE because they

did not remember, 40 or (10%) of the respondents did not because they did not attach

importance to BSE; 122 or (30%) of the respondents did not practice BSE out of sheer levity

for the issue of breast cancer or BSE.

From table 26, data represent that 200 respondents or (49%) often practice BSE, 124

or (31%) practice it very often, and 81 or (20%) of the respondents did not practice BSE often.

Findings indicate low practice rate for CBE. These also show that though a good

number of females did not visit health centers for CBE, they practiced BSE conveniently and

most people were not even consistent with the practice of BSE.This clearly portrays high

levels of negative attitudinal barriers to the success of BRCA campaigns; and as such,

campaigns must appeal to these barriers if success must be achieved.

78

References

Field survey, (2012). Audience response to questions from the questionnaire and interviews.

received 28th June

Lagos State Ministry of Health, (2009). Breast cancer. Lagos state: Breast Cancer

Organization. http://www.brecan.org /

Leathar, D. S., & Roberts. M. M. (1985). Older women's attitudes towards breast disease,

self examination, and screening facilities: implications for communication.

Edinburgh: Springwell House. British Medical Journal. Vol. 290. March.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1417626/pdf/bmjcred00436-0016.pdf

National Cancer Institute. (2009). Cancer type risk factors and possible causes, prevention

detection and diagnosis. Espanol: NCI publications.

http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA

Olatunde, A. (1979). Self medication, benefits, precaution and dangers. London: the

Macmillian Press.

Olweus, D. (1993). Victimization by peers: Antecedents and long term outcomes. In K. H.

Rubin & J. B. Asendorf (Eds). Social withdraswal, inhibition and shyness. Pp.315-

341. Hillsdale, New Jersey: Erlbaum.

Salaudeen A. G., Akande T. M., Musa O. I. (2009). Knowledge and attitudes to breast

cancer and breast self examination among female undergraduates in a state in

Nigeria. Kwara state Nigeria: University of Ilorin. European Journal of Social

Sciences. 7 (3).

Taylor, D., Bury M., Campling, N., Carter S., Garfied, S., Newbould, J., & Rennie, T.

(2007). A Review of the use of the Health Belief Model (HBM), the Theory of

Reasoned Action (TRA), the Theory of Planned Behaviour (TPB) and the Trans-

Theoretical Model (TTM) to study and predict health related behaviour change.

London: University of London. The Department of Practice and Policy, School of

Pharmacy. National Institute for Health and Clinical Excellence (NIHCE). Retrieved

on May 5th, 2012 from http://www.nice-doh_draft_review_of_health_behaviour-

theories.pdf

79

CHAPTER 5

SUMMARY, CONCLUSION AND RECOMMENDATIONS

5.1 Summary

This study looked at the influence of breast cancer campaigns on knowledge, attitude

and practice among women in Benue state. Using the survey research design, quantitative and

qualitative data were gathered and these led to the following findings. The data gathered

indicate that, 300 or (74.1%) of the respondents were aware of sensitization campaigns about

breast cancer, 250 or (62%) of the respondents were exposed to breast cancer campaigns,

while 223 or (55%) named the media- print/electronic as their sources of information

It can also be stated that 284 or (70%) of the respondents know that breast cancer is a

disease that kills; and that 284 or (70%) of the respondents also know that breast cancer

(BRCA) can only be treated at its initial or early stage.

As a result of the above, 284 or (70%) of the respondents showed knowledge of the

fact that, breast cancer stage is early, before symptoms become obvious and should be given

appropriate treatment.

The knowledge level of the women was further measured, and 162 or (40%) of the

respondents said yes to genetic testing, given that they understood the relationship between

genetics as a risk factor in the cause of breast cancer (BRCA). However some of the women

could not mention other factors that can be linked to the causes of BRCA besides genetic

mutations.

It was also deduced that causes of BRCA were not known to many as 243 or (60%)

said they were not sure whether or not BRCA was caused by genetic factors. However, from

table15, it is quite obvious that 365 or (90%) of the respondents know that unhealthy dieting

is a causative factor of BRCA hence, the practice of preventive measures by 94 or (23%) of

the respondents who reduced their consumption of white flours.

80

Also, 284 or (70%) and 365 or (90%) of the respondents respectively, agreed that

knowledge influences attitude towards prevention or treatment, since people underestimate

their risk status, or overestimate their risks status based on the knowledge level they have

about the causes of breast cancer.

` It was also discovered that knowledge about the symptoms is limited to three common

symptoms as revealed in table 20 where 300 or (74%) of the respondents showed knowledge

about breast cancer presentation as lumps, pains and swelling.

Although, the subject of genetic testing is still quite new to the respondents, those

who saw a link between genetics and the cause of breast cancer, expressed their regard for it

as a screening method given that 284 or (70%) of the respondents said that, families that have

hereditary syndrome predisposing to breast cancer should go for genetic testing.

Knowledge about breast cancer is shallow, as the peak age of breast cancer

presentation is not quite known and 155 or (38%) respondents are not sure of the peak age of

breast cancer presentation.

Practice of Clinical Breast Examination is still on the low side, though some factors

seem to inhibit it, as suggested in table 25, where 162 or (40%) of the respondents do not

believe that they are susceptible to the disease. This is evident in the figures provided in table

23 that 270 or (67%) of the respondents do not visit health centers at all. On the other hand,

though 324 or (80%), of the respondents practice breast self examination, only 200

respondents or (49%) practice it often

Results also reveal that 290 or (72%) of the respondents know that mammography is a

form of early breast cancer detection technique, and 284 or (70%) of the respondents know

that, the removal of breast lump does not alter the risks of breast cancer recurrence, and so

caution should be taken.

81

5.2 Conclusion

In conclusion, the women in Benue State are aware of sensitization campaigns about

breast cancer, they are exposed to breast cancer campaigns, and the media- print/electronic

are their major sources of information. Females in Benue state also know that prevention and

early detection are vital aims of the campaigns.

They know that breast cancer is a disease that kills; and that it can only be treated at

its initial or early stage. Most of them acknowledged that before symptoms become obvious,

breast cancer stage is early and should be given appropriate treatment.

The subject of genetic testing is still quite new to the women in Benue State. Those

who understand the relationship between genetics as a risk factor in the cause of breast cancer,

agreed to genetic testing. Again, only a few of them know that mammography is a form of

early breast cancer detection technique

A good number of the women in Benue State attribute the cause of breast cancer to

unhealthy dieting and this is what is known. So, the major causes of breast cancer as provided

by medical prognosis are not known to many. However, the women‟s reduction of

consumption of white flours due to their knowledge of diet as a causative factor of breast

cancer proves that, knowledge influences attitude and positive attitude culminates into

practice.

Furthermore, attitudes of overestimating or underestimating one‟s risks status are

influenced by high or low levels of information acquired on the subject. Also, positive

attitude change is based on compliance of acquired knowledge with pre-existing beliefs,

connectivity of change messages with admired significant others and perception of derivable

benefits.

So many still do not know that other possible factors like having a breast cancer

related infection (breast fibroid, breast cyst) or actions like heating up the breast with

82

radiation can be associated with the disease.

Knowledge among women in Benue state about the symptoms is limited to three

common symptoms namely lumps, pains and swelling. Also, knowledge of the peak age of

breast cancer presentation is not quite known. Again, only a few of them know that, 7-10days

after menstruation is ideal for breast examination. They, however, know that removal of

breast lump does not alter the risks of breast cancer recurrence

Practice of CBE is still on the low side, and such factors as poor attitudes towards the

practice of preventive measures, and the belief that they are not susceptible to the disease

seem to account for it. Practice of breast self examination is, however, relatively high.

5.3 Recommendations

Since the study has revealed that practice of screening methods is highly inhibited by

emotional and psychological factors, it recommends that campaigns should be structured to

adequately accommodate these factors and effectively appeal to these negative attitudinal

barriers if success must be achieved.

Prevention of breast cancer should be emphasized paying serious attention to factors

that are responsible and how they can be effectively handled. This is very important, since the

cure of breast cancer is based on the type of cancer, the stage of diagnosis and the extent of

diagnosis; which could start from the last stage. If preventive measures are taken seriously,

survival rates will invariably increase since cure of cancer is not certain despite medical

techniques and treatments available.

The aim of cancer control is a reduction in both the incidence of the disease and the

associated morbidity and mortality, as well as improved life for cancer patients and their

families. In addition to substantial opportunities for primary prevention, the World Cancer

Report, also, emphasizes the potential of early detection, treatment and palliative care. It

urges all countries to establish comprehensive national cancer control programmes, aimed at

83

reducing the incidence of the disease and improving the quality of life for cancer patients and

their families. In developing countries in particular, where a large proportion of cancers are

detected late in the course of the disease, efforts to achieve earlier diagnosis and delivery of

adequate palliative care and pain relief deserve urgent attention (W.H.O. reports 2011).

The study, also, recommends that campaign planners, should lower the age for

screening and mammograms so that early detection and presentation at the hospital is

enhanced, even though it has been discovered that early detection is not a guarantee of

survival given that some types of breast cancers resist all forms of medications available as

they spread to the bones and brain. However, if screening is done at an earlier age, early

treatment could better reduce the risk of early death. A breast cancer statistics given by The

World Cancer Report (2011:1) revealed that about 24 per cent of new breast cancer cases

diagnosed in 2007 were in women younger than 50 years; 51 per cent in women aged 50-69;

and 25 per cent in women aged 70 and above. This suggests that early screening might just be

helpful in elongating life span. Early screening, particularly for cervical and breast cancers,

allows for successful treatment.

The study also recommends a healthy lifestyle as the best form of prevention.

Frequent consumption of fruits and vegetables and physical activity can make a difference.

Dietary recommendation also requires close coordination by campaign planners with

programs for the prevention of other related non-communicable diseases, mainly

cardiovascular diseases, chronic obstructive pulmonary diseases and diabetes (IARC 2011).

Policy makers should therefore make do with the latest information provided by the

independent Expert Report on diet and chronic disease, released in March 2003 by WHO and

FAO (Food and Agriculture Organization) in order to know which information will be most

appropriate for them to base advice on prevention of breast cancer and other related diseases

(World Cancer Report).

84

References

The World Cancer Report, (2011). Global cancer rates could increase by 50% to 15 million

by 2020 http://www.who.int/mediacentre/news/releases/2003/pr27/en/

The International Agency for Research on Cancer, (2010). World cancer report provides

clear evidence that action on smoking, diet and infections can prevent one third of

cancers, another third can be cured.

http://www.who.int/mediacentre/news/releases/2003/pr27/en/ IARC reports

World Health Organization (2011). WHO statistical information system. Geneva: World

Health Organization. Retrieved April 20, 2012 from http://www.who.int/whosis.

http://www.who.int/cancer/FINAL-Advocacy-Module%206.pdf

85

Bibliography

Books Anaekwe, M. C. (2002). Basic research methods and statistics in education and social

sciences. Onitsha, Anambra State: Sofie Publicity and printing Ltd

Baran, S. J. & Davis, D. K. (2012), Mass communication theory: Foundations, ferment, and

future. (6th ed). United States: Wadsworth Cengage Learning

Bardsley, C. H. (2009). Opiods. In J. A. Marx(Ed). Rosen’s emergency medicine: concept

and clinical practice. (7th ed). Philadelphia, PA: Mosby Elsevver.

Bhopal, R. (2002). Concepts of epidemiology. New York: Oxford University Press

Chukwuemeka, E. O. (2002). Research methods and thesis writing: A multi- disciplinary

approach. Obiagu Enugu: Hope- Rising Ventures Publishers.

Errosnman, H. (1998). Tropical physical and health education. USA: Fildman Publishers

Green, L. W. & Kreuter, M. W. (1999). Health promotion planning: An educational and

ecological approach. Canada: CA, Mayfiled.

Haro, M. S., Percel, G. S. & Wirege, J. R. (2001). Explanation in personal health. USA:

Houghton Mifflin Company.

Ikponmwosa, O. (2006). Fundamentals of statistics in education and the social sciences. (3rd

ed) lagos, Accra: National book consortium

Linus, I. O. (2006). Understanding research methods and thesis writing. Enugu: Linco

enterprises. ISBN: 978-059-216-4

Lindberg, L. D., Bogess, S. & Williams, S. (2000). Multiple threats: the co-occurrence of

teen health risks behaviours. USA: Urban Institute: Office of the Assistant Secretary

for Planning and Evaluation (ASPE)

Mcquail, D. (2010).Mass communication theory: An introduction. Netherlands: Sage

Publishers

Nwana, O. C. (1990). Research in Health Communication at University of Nigeria Nsukka. In

P. Obanya (Ed). Aspects of Nigerian educational literature.

Nwodu, C. L. (2006). Research in communication and other behavioural sciences: Principles

methods and issues. Enugu: Rhyce Kerex publications

Olatunde, A. (1979). Self-medication, benefits, precaution and dangers. London: the

Macmillian Press.

Olson, J. S. (2002). Bathsheba's breast: Women, cancer and history. Baltimore: The Johns

Hopkins University Press. ISBN 0-8018-6936-6

86

Osuala, E. C. (2005). Introduction to research methodology (3rd

ed.). Onitsha:

Africana-First Publishers Limited.

Park, K. (2009). Parks textbook of preventive and social medicine (20th ed). India:

Banarsidas Bhanot Publishers.

Sulik, G. (2010). Pink ribbon blues: How breast cancer culture undermines women's health.

New York: Oxford University Press. ISBN 0199740453

Sunder, L., Adarsh & Pankaj (2009). Textbook of community medicine; preventive and social

medicine (2nd ed). New Delhi, India: CBS Publishers and Distributors.

Wimmer, R. D. & Dominic, J. R. (2011). Mass media research: An introduction. (9th ed),

Wadsworth: Cengage

Journals

Bertlett, J. Kotrlik, J. & Higgins, C. (2001). Organisational research: Determining

appropriate sample size in survey research. Information Technology, Learning and

Performance Journal. 19 (1) pp.43-50

Breckler, S. J. & Wiggins, E. C. (1992). On defining attitude and attitude theory: once more

with feeling. In A.R. Pratkanis, S. J. Breckler, & A. C. Greenwald (Eds), Attitude

structure and function. Hillsdale, NJ: Erlbaum. P 407

Eagly, A.& chaiken, S. (1995). Attitude strength, attitude structure and resistence to change.

In R. Petty and J. Kosnic (Eds) Attitude strength. (PP 413- 415) Mahuah NJ: Erlbaum.

Olwues, D. (1993). Victimization by peers: Antecedents and long term outcomes. In K. H.

Rubin & J. B. Asendorf (Eds). Social withdraswal, inhibition and shyness. Pp.315-

341. Hillsdale, New Jersey: Erlbaum.

Oyero, O. (2010). Child Rights and Media Democratization: An Agenda for Realization of

the MDGS in Nigeria. In N. Okoro, S.O. Idemili, P.C. Agba, N.F. Iyama, N.

Udoakah, H.G. Igben etal (Eds) International journal of communication: An

interdisciplinary journal of communication studies. Number 11. Nsukka:

Communication Studies Forum.ISSN: 1597-4324

Thesis

Akwuba, S.E. (2012). Attitude to caesarean delivery among mothers attending antenatal

clinics at general hospitals in Anambra State. Unpublished thesis, University of

Nigeria Nsukka

Aleke, C.O. (2012). Incidence of drug abuse and cigarette smoking among secondary school

students in Ezza North local government area, Ebonyi State. Unpublished thesis,

University of Nigeria Nsukka

Ngwu, C. S. (2011). Nigerian newspapers coverage of the 78 days presidential vacuum

crisis under late President Umaru Musa Yar’adua: A study of the Daily sun,

87

Guardian. The Nation and Vanguard newspapers. Unpublished thesis Enugu State

University of Science and Technology, (ESUT), Enugu.

Online Books and Journals

Akpo, E.; Akpo, M. &Akhator, A. (2010). Breast cancer knowledge and screening practices

among nigerian medical students. Delta: Delta State University. The Internet Journal

of Health. 11 (2). Retrieved April 18th, 2012 from http://www.ispub.com/journal/the-

internet-journal-of-health/volume-11-number-2/breast-cancer-knowledge-and-

screening-practices-among-nigerian-medical-students.html

American Cancer Society, (2009). Breast cancer: Early detection.. Retrieved April 18th 2012

fromhttp://www.cancer.org/docroot/CRI/content/CRI_2_6x_Breast_Cancer_Early_De

tection.asp.

Chustecka, Z. (2011). Cancer in Africa is 'Like a Runaway Train'. Medscape Medical

News 2011 WebMD, LLC. http://www.medscape.com/viewarticle/736870

Chris, K. H T. & Beng I. (2010). Knowing your breasts. minimizing breast cancer

risk! understand risk factors, preventive measures and early detection. Malaysia.

http://www.bookoncancer.com/productDetail.php?P_Id=8

Ferrandis, E. D. Andreu, Y. & Galdón, M. J. (2002). The impact of information given to

patients’ families: Breast cancer risk notification. Análise Psicológica , 1 (20): 27-34.

http://www.scielo.oces.mctes.pt/pdf/aps/v20n1/v20n1a03.pdf. Retrieved April 18th,

2012

Health belief model, (2012). Retrieved May 5th

, 2012 from

http://en.wikipedia.org/wiki/Health_belief_model

Lagos State Ministry of Health, (2009). Breast cancer. Lagos state: Breast Cancer

Organization. http://www.brecan.org /

Leathar, D. S., & Roberts. M. M. (1985). Older women's attitudes towards breast disease,

self examination, and screening facilities: implications for communication.

Edinburgh: Springwell House. British Medical Journal. Vol. 290. March.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1417626/pdf/bmjcred00436-0016.pdf

Loewensten, G. (2007). Affect regulation and affective forecasting. In Gross, J. J. (Ed.)

Handbook of Emotion Regulation (pp. 180–203). New York: Guilford.

http://en.wikipedia.org/wiki/Health_belief_model

MTN Foundation, (2011). MTN foundation commissions a series of state-of-the-art dialysis

and mammography centers around Nigeria. 28th February, 2011 - 10:18 AM

http://www.mtnonline.com/mtnfoundation/content/mtn-foundation-commissions-

series-state-art-dialysis-and-mammography-centres-around-nigeriaRetrieved April 18th 2012

National Cancer Institute. (2009). Cancer type risk factors and possible causes, prevention

detection and diagnosis. Espanol: NCI publications.

http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA

88

National Statistical Service, (2012). Australian calculator. Retrieved 6th May, 2012

from http://www.nss.gov.au/nss/home.nsf/NSS/0A4A642C712719DCCA2571AB00

243DC6?opendocument

National Population Commission, (2006). Census report. UNFPA in Benue State: Annual

report. http://nigeria.unfpa.org/benue.html. Retrieved 6th May, 2012

Okobia M. N, Bunker, C. H., Okonofua F.E.,& Usifo O. (2006). Knowledge, attitude and

practice of nigerian women towards breast cancer: a cross-sectional study. Edo state:

university of Benin. February 21,World J Surg PMCID: PMC1397833 Oncol.

doi: 10.1186/1477-7819-4-11

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1397833/ retrieved April 18th

2012

Salaudeen A. G., Akande T. M., Musa O. I. (2009). Knowledge and attitudes to breast

cancer and breast self examination among female undergraduates in a state in

nigeria. Kwara state Nigeria: University of Ilorin. European Journal of Social

Sciences. 7 (3). http://www.eurojournals.com/ejss_7_3_15

Shea, N., & Remoker C. (2011). The health belief model. PP 1-3.Retrieved on May 5th,

2012 http://www.Nicole_shea_and_catriona_Remoker_The_Health_Belief_Model

Stretcher, V., & Rosenstock, I.M. (1997). The Health Belief Model. In Glanz K., Lewis F. M.,

& Rimer B. K., (Eds). Health Behaviour and Health Education: Theory, Research

and Practice. San Francisco: Jossey- Bass. PP 31-36. Retrieved on May 5th 2012

from http://www.health_belief_model.org

Sule, E. A. (2011). Breast cancer awareness and breast examination practices among women

in a nigerdelta hospital. Delta state: Wilolud Journals,

Continental J. Medical Research 5 (1) pp27 - 31, ISSN: 2141 – 4211

http://www.wiloludjournal.com

The World Cancer Report, (2011). Breast cancer statistics

http://canceraustralia.nbocc.org.au/breast-cancer/about-breast-cancer/breast-cancer-

statistics

Taylor, D., Bury M., Campling, N., Carter S. et al (2007). A Review of the use of the Health

Belief Model (HBM), the Theory of Reasoned Action (TRA), the Theory of Planned

Behaviour (TPB) and the Trans-Theoretical Model (TTM) to study and predict health

related behaviour change. London: University of London. The Department of Practice

and Policy, School of Pharmacy. National Institute for Health and Clinical Excellence

(NIHCE). Retrieved on May 5th, 2012 from http://www.nice-

doh_draft_review_of_health_behaviour-theories.pdf

The World Cancer Report, (2011). Global cancer rates could increase by 50% to 15 million

by 2020. http://www.who.int/mediacentre/news/releases/2003/pr27/en/.

The International Agency for Research on Cancer, (2010). World cancer report provides

clear evidence that action on smoking, diet and infections can prevent one third of

89

cancers, another third can be cured. http://www.who.int/mediacentre/news/releases/2003/pr27/en/ IARC reports.

UNFPA, (2010). UNFPA in Benue State: Annual report. http://nigeria.unfpa.org/benue.html

retrieved 6th May, 2012

Welch, H. G. (2010). "The Risk of Being Too Aware". The Los Angeles Times. ISSN 0458-

3035, 20th October. Retrieved April 18th, 2012 from

http://www.latimes.com/news/opinion/commentary/la-oe-welch-mammograms-

20101020,0,2961910.story.

World Health Organization (2011). WHO statistical information system. Geneva: World

Health Organization. Retrieved April 20, 2012 from http://www.who.int/whosis.

http://www.who.int/cancer/FINAL-Advocacy-Module%206.pdf

Wood, W. (2000). "Attitude Change: Persuasion and Social Influence". Annu. Rev.

Psychol 51: 539–570.

http://en.wikipedia.org/w/index.php?title=Attitude_change&oldid=489610647

90

Appendix I

Questionnaire

Department of Mass

Communication, University of

Nigeria Nsukka

19th April, 2012

Dear Respondent,

I am a post graduate student of the department of mass communication, conducting a

research study on Breast Cancer Campaigns. The motive for the study is purely academic.

Under no situation is the researcher intending to transfer the information that would be

generated to any other person. I therefore solicit for your response to the questions provided

below.

You may want to know that all answers will be treated confidentially. Thanks for your

cooperation.

Yours faithfully,

Grace, Ebi Omerigwe

91

Appendix II

A Questionnaire on Breast Cancer Campaigns

Part A

Instruction: please tick (√) as appropriate in the boxes below

PERSONAL DATA

1. Sex: male ( ) female ( )

2. Occupation: civil servant ( ) business ( ) student ( ) any other

specify ……………………………………………………………………..

3. Educational Qualification: None ( ) SSCE ( ) DIPLOMA ( ) B.SC ( ) MA. /M.SC.

( )

4. What is your status? Free ( ) infected ( )

5. Age 15 - 25 ( ) 26 - 36( ) 37 – 47( ) 48 and above ( )

Part B: Awareness, Knowledge, Attitude and Practice

6. Are you aware of breast cancer campaigns? Yes ( ) No ( ) Not sure ( )

7. Are you exposed to breast cancer campaigns? Yes ( ) No ( ) Not sure ( )

8. What is your source of information about breast cancer? Friends and street van

shows( ) relations( ) media print/electronic ( ) medical doctors and medical seminars

( )

9. What do you think is the sole aim of the campaigns? Early detection ( ) prevention ( )

all of the above ( )

10. What do you know about breast

cancer? …………………………………………………………………………………

………………………………………………………………………….

………………………………………………………………………………….

11. At what stage is breast cancer treatable? Early stage ( ) middle ( ) late stage ( )

Don‟t know ( )

92

12. When is the early stage? Shortly after identifying symptoms( ) much later ( ) when

the condition can no longer be treated ( ) Don‟t know ( )

13. Should women go for genetic testing? Yes( ) No( ) Not sure ( )

14. Do you know that genetic factors can cause breast cancer? Yes ( ) No( ) Not sure( )

15. Do you know that dieting/nutrition is also a causative factor of breast cancer? Yes( )

No( ) Not sure( )

16. How do you control calories or excess fat in your

diet?..................................................................................................................................

......................................................................................................................

Attitude and knowledge

17. Are there people who underestimate their risks status? Yes( ) No( ) Not sure( )

18. Are there people who over estimate their risk status? Yes( ) No( ) Not sure( )

19. Beside the genetic mutations what do you think can cause breast

cancer?...................................................................................................................... ........

.....................................................................................................................

20. What are the symptoms of breast cancer?

Lumps, swelling, pains ( ) Reddening of nipples/Dimpling ( ) Don‟t know ( )

21. Do you agree that families that most likely present a hereditary syndrome

predisposing to breast cancer should go for genetic testing? Yes( ) No( )

Not sure ( )

22. Do you know that among Nigerian women, the peak age of breast cancer presentation

is about 10-15years earlier than what is observed in Caucasian(white) women, where

it occurs between the ages of 35-45 years? Yes( ) No( ) Not sure( )

93

Practice and Knowledge

23. How often do you visit health centers for clinical breast examination (CBE)?

Often ( ) very often ( ) Not often ( ) Not at all ( )

24. Do you practice breast self examination (BSE)? Yes ( ) No ( )

25. If no, why don‟t you practice it? ...........................................................................

…………………………………………………………………………………..

26. How often do you self examine your breast? Often( ) very often( ) Not often( )

27. What do you look out for when conducting breast self examination?

Lumps, swelling, pains ( ) Reddening of nipples ( )Dimpling( ) Not sure( )

28. Are Periods between seven to ten days after menstrual period (AMP) ideal for breast

examination? Yes ( ) No ( ) Not sure ( ).

29. If no, what periods are most ideal? ........................................................................

…………………………………………………………………………………...

30. Is mammography a form of early breast cancer detection technique? Yes ( ) No ( )

don't know ( ).

31. Do you know that removal of breast lump does not alter the risks of breast cancer

recurrence? Yes ( ) No ( ) not sure ( )

94

Appendix III

Interview Questions

First segment of interview

3 Females within the specified age range

1. How many breast cancer campaigns have you attended since 2008? RQ 1

2. How has your knowledge level of breast cancer, risk factors, prevention, early

detection and treatment, increased due to exposure to the campaigns? RQ3

3. What is breast cancer?

4. What are the various screening methods known to you? RQ2

5. To what extent do you think women should carryout BSE, CBE, Mammography and

Genetic testing? RQs 4 & 5

6. Why should women take these preventive practices seriously? RQ4 &5

Second segment of interview

An Oncologist

1. What are the causes of breast cancer?

2. Why are black women said to be more predisposed to breast cancer than the

Caucasians (whites)?

3. Why do women need genetic testing?

4. What is the breast cancer mortality rate in Benue State?

5. At what stage would breast cancer no longer be treatable?

6. Where in Benue state are breast cancer screening practices performed?

95

Appendix IV

Breast Cancer Stages

Surgery: partial mastectomy and removal of lymph nodes

Source: Hasham, posted in Breast cancer causes, women problem breast cancer. Retrieved

on the 13th of August, 2012

96

Appendix V

Symptoms of Breast Cancer