CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF STUDY

The Cancer Statistics Worldwide (2005) documented that worldwide; more than one million new cases of female breast cancer are diagnosed each year, making it the most commonly occurring disease in women, accounting for over 1/3 of the estimated annual 4.7million cancer diagnosis in females and the second most common tumor after lung cancer in both sexes. It is also the most common female cancer in both developed and developing countries with 55% of it occurring in the developing countries. In addition, the annual worldwide incidences had almost doubled since 1975 and the prevalence and incidences increased with increasing age (Althuis, 2005). The report explained further that breast cancer is a major public health problem in developed countries, claiming over one million lives annually especially in industrialized nations. Statistics show that countries like United States of America, Italy, Australia, Germany, The Netherlands, Canada and France have the highest overall breast cancer rates while developing countries with lower breast cancer rates are Northern Africa and Eastern Asia (World Health Organization, 2006). Death rates of 76/100,000 females was estimated to occur in 2020.

         Breast cancer is the leading diagnosed cancer and the second most common cause of cancer mortality in sub-Saharan Africa. Sub-Saharan Africa has the highest agestandardized incidence rate of 17.3 per 100,000 women per year, globally; with the Southern Africa region and West African region having the highest age-standardized incidence rate of 38.9 and 38.6 per 100,000 women per year in sub-Saharan Africa, respectively. However, the Northern Africa region has the highest incidence rate of 43.2 ASR incidence in the whole of Africa (Azubuike, 2018). Country-specific prevalence shows that there is a 15.3%, 4.6% and 3.3% prevalence of breast cancer in the Central African Republic, Rwanda and Sierra Leone, respectively. Mauritius and Nigeria have been said to be the countries with the highest incidence in Africa at 64.2 and 50.4 ASR incidence per 100,000 repetitively (Azubuike, 2018). The 5-year age-standardized relative survival in 12 sub-Saharan African countries was 66% for cases diagnosed during 2008 through 2015, sharply contrasting with 85% to 90% for cases diagnosed in high-income countries from 2010 through 2014 (Allemani C, 2018). A multi-country estimate of 3-year survival of breast cancer patients was 50% between 2014 and 2017. Western African region has the highest mortality rate of 20.1 ASR mortality per 100,000; with central African region having the least mortality rate of 14.9 ASR mortality globally.

         On the burden of cancer in Nigeria, Lambo (2007) explained that there is likely to be 100,000 new cases each year, and that by 2010 there may be 500,000 new cases. To understand the problem facing cancer patients in Nigeria, it is worthy of note that the survival rate for breast cancer in the Unites States of America. is 85 % while it is a dismal 10% in Nigeria Olopade, 2004). Durosimi (2004) reported a survival rate of 1.9% for Nigeria and over 50% for East Africa and other countries. The Lagos State Ministry of Health documented that the annual 15% of the cases occur in women less than 30 years. The delivery of individualised treatment in oncology is predicated upon accurate and adequate description of the biologic, cytologic and molecular description of the cancer, and it is difficult to develop an evidence-based individualised treatment plan with inadequate or inaccurate pathologic, molecular and cellular characterisation of the disease (Goldhirsch A, 2013). In Nigeria, like many low- to middle-income countries, efforts to provide comprehensive pathology reporting remain incongruent and inadequate in many places (Masood S, 2008). The reasons for this are multifactorial and are undeniably impacted by socioeconomic and health-sector factors unique to the region (Sayed S, 2015). Some of these include lack of basic infrastructure like laboratory supplies, basic equipment and skilled personnel, as well as inadequate government policies on standardisation of laboratory testing, resulting in a lack of access to valuable pathological options including immunohistochemistry testing, and frozen sections that are valuable in the clinical outcome of breast cancer patients (Wilson L, 2018). Some authors have documented improvement in various aspects of pathology reporting in the country, and there is a consensus to develop a uniformly accepted, implemented and monitored template for pathology reporting in the region (Sayed S, 2015). Several cross-sector national and global groups have proposed practice guidelines and developed a minimum set of reporting criteria to improve the standardisation of breast cancer pathology reporting worldwide. Despite these efforts, there is still insufficient specimen documentation in Nigeria, with no nationally-enforced consensus on minimum reporting requirements. As such, generated reports can vary widely depending on the state, institution, centre or reporting laboratory, forcing treating oncologists to make decisions with inadequate data.

         Cancer is a broad term given to a collection of related diseases characterized by the abnormal growth of tumors on the organs of the body. There are two types of tumors, benign tumors and malignant tumors (which are known as cancerous tumors). The two types are distinguished by examining the tissue (taking a sample) (W.H.O, 2015). Breast cancer is a cancer that develops due to uncontrollable changes in the function or growth of the cells forming breast tissue. These changes transform these cells into cancerous cells that have the ability to spread. Breast cancer can occur in both men and women, but it is more common in women.

         Despite the growing campaigns on breast cancer awareness in Nigeria generally and Southeast particularly (Okobia, Bunker, Okonofua, et al., 2006), the rates of its spread tend to grow while the practice of requiredremedial practices continue to vary widely among women. Most of the rural women are either unaware of the cancer, have poor knowledge of breast cancer, or exhibit poor preventive and curative practices (Akpo, 2010; Makanguola, Amoo, Ajibade, et al., 2003). Consequently, civil society organisations, and relevant agencies in the Southeast Nigeria embarked on multiple media programmes using different radio channels, televisions, newspapers, and social media to create awareness of the cancer, its preventive and curative behaviours or measures.

         Breast cancer is the most common cancer found in women and one of the leading causes of death among all forms of Cancer (Smith, Cokkinides & Brawley, 2008). It is a feared disease, not only because it is lifethreatening, but also it can affect a woman’s sense of self-concept, her sexuality and femininity. In the past, breast cancer incidence trends in the developed country like US have shown gradual increase between 1973 and 1982 and a period of more rapid increase between 1982 and 1986 (Khatib & Modjtabai, 2006) but since 2005, the overall incidence have shown overall trends to stabilize. This is believed to be related to the use of breast cancer screening methods. Although population-based data showed that white women are affected by breast cancer at a 20% higher rate than black women, the reverse is true for women younger than 40 with black women affected 10- 40% more than white women (Reisi, Javadzade & Sharifirad, 2013).

         It is interesting to know that as debilitating as breast cancer disease is, majority of Nigerian women have little or no knowledge of the disease and even in situations where they are aware of the disease, their attitudes towards seeking healthcare is negative causing their untimely or preventable death. It has been observed that certain socio-cultural, religious, genetic and economic factors are responsible for this negative attitude. Literature Review It has been argued that a lack of basic knowledge and quality information delivery system for breast cancer is a great impediment to the life and well-being of women (Ramathuba D, 2015). Breast cancer has been a major cause of death subtly killing women – especially those with little or no education. This is compounded by the lack of timely information about breast cancer and poor diagnostics screening methods for early detection (Ramathuba D, 2015). As important as knowledge of breast cancer is, it is not sufficient unless socio-cultural factors are taken into consideration by the health professional providing direct health-care. Insufficient information concerning breast cancer has also been observed among the rural and urban dwellers in Nigeria; it is responsible for the poor perception of the ability to cure cancer earlier detected and the efficacy of screening tests. Furthermore, the lack of awareness on the issue of vulnerability and susceptibility associated with breast cancer discourage many women from seeking intervention early or associate the symptoms they are experiencing with other health conditions (Ramathuba D, 2015).

         The health belief model is theory discussed in this study. Health beliefs and attitudes are the two main factors indicated by researches that can affect the decision of women to be screened for breast cancer (Erbil & Bolukbas, 2014; Akhtari-Zavare et al., 2015). This fact was proven in Asian countries such as Korea, Turkey and Iran in which, women’s perceived benefits of screening were positively related to early detection behaviors and the lack of it resulted in them ignoring their health care needs (Ahmadian & Samah, 2013). A body of evidence convincingly indicates that culturally-based attitudes and religious beliefs play an important role in defining women’s screening behaviors (Kwok et al., 2015). Arab women for example believe that health and illness are determined by the will of God (Donnelly et al., 2013; Kwok et al., 2015). Similarly, many Chinese women believed that screening measures are meaningless and their destiny will not change if they were fated to have cancer (Kwok et al., 2015; Shang et al., 2015). The low rate of participation amongst Asian women in mammography for example, is attributable from their intention or attitude and these attitudes are possibly enhanced by their beliefs about the foreseeable outcomes from the screening accomplishments (Ahmadian & Samah, 2013). There have been series of studies on breast cancer but not even a single research is centered on knowledge and attitude of female undergraduate students of university of Nigeria, nsukka towards breast cancer media awareness campaign

1.2 STATEMENT OF THE PROBLEM

One of the fatal diseases that has put the planet in danger is cancer. The rise in breast cancer-related attacks and fatalities raises an important question regarding the impact of breast cancer awareness efforts on women and their inadequate responses to early breast cancer presentation.

Given the foregoing and the American Cancer Society's confirmation that breast cancer deaths are still preventable at an early stage, the researcher critically assessed the effectiveness of media campaign programs on breast cancer in causing quick and prompt positive changes in the way that women perform their BSEs and CBEs, which will lead to a decrease in their mortality rates. Finally, several researches has been carried out on the effect of media on breast cancer campaign in several part of Nigeria but not even a single research has been carried out on knowledge and attitude of female undergraduate students of university of Nigeria, nsukka towards breast cancer media awareness campaign.

1.3 SPECIFIC OBJECTIVES

• To determine the level of Knowledge of Breast Cancer Media Awareness Campaign among female Undergraduate Students of UNN.
• To determine the level of knowledge of Breast Cancer Media Awareness Campaign among female Undergraduate Students of UNN based on class level.
• To determine the level of knowledge of Breast Cancer Media Awareness Campaign among female Undergraduate Students of UNN based on age.
• To determine the attitude of female Undergraduate Students towards Breast Cancer Media Awareness Campaign in UNN.
• To determine the attitude of female Undergraduate Students towards Breast Cancer Media Awareness Campaign in UNN based on class level.
• To determine the attitude of female Undergraduate Students towards Breast Cancer Media Awareness Campaign in UNN based on age.

1.4 RESEARCH QUESTIONS

• What is the level of Knowledge of Breast Cancer Media Awareness Campaign among female Undergraduate Students of UNN?
• What is the level of knowledge of Breast Cancer Media Awareness Campaign among female Undergraduate Students of UNN based on class level?
• What is the level of knowledge of Breast Cancer Media Awareness Campaign among female Undergraduate Students of UNN based on age?
• What is the attitude of female Undergraduate Students towards Breast Cancer Media Awareness Campaign in UNN?
• What is the attitude of female Undergraduate Students towards Breast Cancer Media Awareness Campaign in UNN based on class level?
• What is the attitude of female Undergraduate Students towards Breast Cancer Media Awareness Campaign in UNN based on age?