ABSTRACT
This research was carried out to assess the Knowledge, Attitude and Practice of Mammographic Screening among Female Staff of University of Nigeria, Enugu Campus (UNEC) in view of the low record of this population at the mammographic Unit of the University of Nigeria Teaching Hospital, Ituku-Ozalla. Both academic and non-academic female staff within the age range of 35-64 employed by the University of Nigeria constituted the population of this study. Quota sampling technique was employed to divide the population into six quotas, after which a random sampling technique by balloting was used to select the proportionate sample from each quota as determined by the ratio of their population to one another after obtaining a list from all the departmental secretaries. A total of 220 questionnaires were distributed and 204 finally returned duly completed. For data analysis, answers were described as knowledge, attitude, practice and their respective adequacies and then they were correlated with control variables through the chi-square test.The findings of this research showed that the knowledge of mammographic screening was high but their practice was low. The reason for poor practice was found to be related the gross negligence of the importance of mammographic screening among the studied population. Few respondents also complained of fear of radiation and that lack of referral by the doctors as a reason for non compliance to the practice of mammographic screening among the respondents. This calls for a more focused enlightenment campaign on the importance of mammographic screening in the early detection of breast cancer which remains the only way of arresting the fatal tendency of this scourge.
TABLE OF CONTENTS
Title Page -----------i
Dedication -----------ii
Acknowledgement---------iii
List of Tables ----------iv
List of Figures ----------v
Abstract -----------vi
Table of Contents----------vii
CHAPTER ONE: BACKGROUND OF THE STUDY
1.1 Introduction ---------1
1.2 Statement of Problem --------3
1.3 General Objectives ---------4
1.4 Specific Objectives ---------4
1.5 Significance of the Study--------4
1.6 Statement of Hypothesis --------5
1.7 Scope of the Study---------5
1.8 Operational Definition of Terms -------5
1.9 Review of Related Literature-------7
CHAPTER TWO: THEORETICAL BACKGROUND OF THE STUDY
2.0 Brief Anatomy of the Study-------12
2.1 Breast Cancer ---------14
2.2 Mammographic Screening; Method of Early Breast Cancer Detection--23
CHAPTER THREE: RESEARCH METHODOLOGY
3.1 Study Design ----------28
3.2 Population of the Study and Sample Size-----28
3.3 Sample Technique---------28
3.4 Determination of Sample Size------28
3.5 Source of Data ---------29
3.6 Method of Data Collection --------29
3.8 Selection Criteria ---------30
39 Materials ----------31
CHAPTER FOUR: DATA PRESENTATION, ANALYSIS AND TEST OF HYPOTHESIS
4.1 Data Presentation and Analysis-------32
4.2 Test of Hypothesis--------38
CHAPTER FIVE: DISCUSSION, SUMMARY OF FINDINS, CONCLUSION AND RECOMMENDATIONS
5.1Discussion ----------40
5.2 Summary of Findings--------43
5.3 Conclusion----------44
5.4 Recommendations---------44
5.5 Limitation of the Study--------44
References
Appendix
LIST OF TABLES
Table 1: Age distribution of the respondents
Table 2: Literacy level of the respondents
Table 3: Responses on the knowledge of mammographic screening
Table 4: Responses on attitude towards mammographic screening
Table V: Responses on the practice of mammographic screening
Table VI: Responses on the knowledge of breast cancer and its risk factors.
Table VII: Statistical correlation of knowledge of mammographic screening with level of literacy of the respondents
Table VIII: Statistical correlation of age of the respondents with practice of mammographic screening
LIST OF FIGURES
Fig. 1: Tumour sizes
INTRODUCTION
Breast cancer is one of the most common malignancies in Nigeria1,2,3,4. It is the leading cause of cancer related death and accounts for almost one in every five of all cancer-related deaths among women5. While incidence of breast cancer continues to increase, one clear point to note as regards its diagnosis and treatment is that the earlier the detection, the better the prognosis6. There are widely used effective screening techniques that enhance early detection of breast cancer. These screening techniques include breast self examination (BSE), Clinical Breast Examination (CBE), Mammography, etc. Of all these three techniques, mammography is said to be the best and most reliable method for early detection of breast cancer since it can detect 40% of early breast cancer.7 It is also considered a preferred modality of choice owing to its relative affordability5.
Mammography is the x-ray examination of the breast using low energy beam of radiation. This provides fine details of the soft tissue especially the presence of calcification of soft tissue masses enabling the diagnosis of early breast cancer. To be able to achieve this, Mammography machines compresses and flattens the breast8. Then a low kVp value typically 28kVp is used to traverse the breast tissue. Radiation dose must be minimized due to the radio-sensitivity of the breast tissue9.
Mammography is carried out on both symptomatic and asymptomatic women with known history or suspected abnormality of the breast and as a screening procedure in well, asymptomatic woman9. Thus, mammography can be classified into two types namely diagnostic and screening mammography.
Diagnostic mammography refers to the use of mammography to check for breast cancer on women found with breast lump or other signs of breast cancer (symptomatic women). Such symptoms as dimpling of the nipple, change in breast shape, thickening of the skin, nipple discharge are always involved.
Screening mammography on the other hand is usually recommended to women who are most likely to develop (i.e predisposed to) breast cancer and women who are apparently healthy (asymptomatic women).
Diagnostic mammography takes longer time than screening mammography because more x-rays are needed to obtain views of the breast from different angles. Not all age group and everywoman should go for screening mammography. The recommendation for mammographic screening by American College of Radiology and American Cancer Society applies for every woman calling for annual mammograms starting at the age of 4010 though some suggest 35years.
Another guidelines for breast cancer screening recommended by a consortium of American medical organizations including the American Cancer Society, stipulates that: between the ages of 40 and 49 years, women should undergo a Clinical Breast Exam (CBE) and mammography every year or two; women older than 50 years should have an annual CBE as well as a mammogram22. Mammography and CBE facilitate early detection and treatment of breast cancer, which is responsible for lower mortality rates12. In a screening setting, about 10% of breast cancers will only be detected by CBE11.
According to the data of breast cancer incidence distributed across various ages by Pahu and Hahn, breast cancer is less among women less than 50years of age10.
In spite of all efforts towards awareness of breast cancer, its incidence has still remained on the rise. This goes to suggest that lack of information cannot be the only factor in favour of this ugly trend. Thus, other factors like negative attitude and misconception among women are suspected to be connected.
Studies have examined the knowledge, attitude and practice of women towards breast cancer in Nigeria6,11,13. But even though some of these studies have given kudos to education as an important tool in the creation of satisfactory knowledge about mammography screening among women, the low record on the part of female staff of University of Nigeria, Enugu campus in mammography Unit as observed in University of Nigeria Teaching Hospital (UNTH) contradicts such results. Thus, this research has been designed to assess the knowledge, attitude and practice of mammographic screening among the educated women who constitute the staff of University of Nigeria, Enugu campus towards mammographic screening.
