Lupine Publishers | Scholarly Journal Of Psychology And Behavioral Sciences
https://lupinepublishers.com/psychology-behavioral-science-journal/fulltext/breast-cancer-awareness-knowledge-and-beliefs-among-libyan-women.ID.000135.php
Abstract
Background: Breast cancer
(BC) is the most frequent cancer of women. The high mortality in developing
countries is associated with late detection, and lack of knowledge among women
and adequate screening programmes.
Objectives: The objectives of
this study are assess the current level and determinants of knowledge and
beliefs regarding (BC), risk factors and various screening methods among Libyan
women.
Methods: A cross-sectional
descriptive study carried out between September and October 2016 among a sample
of adult women in western Libya. Participants were asked to fill a validated
questionnaire to investigate their knowledge about the risk factors as well as
their awareness and screening behaviours of (BC). Data were collected from 1091
woman.
Results: The results of
the study showed the majority of women participated in the study were aware of
BC early warning signs and symptoms with over 90% of the women were able to
list at least one symptom of breast cancer correctly. The most frequent warning
sign identified was breast lump (91.0 %), followed by discharge from the
nipples (80.6%). Also, 565 (52.7%) of those surveyed were aware that increasing
age was associated with a higher incidence of breast cancer and 747 (68.3%) of
the respondents identified positive family history as a risk factor for breast
cancer. Moreover, 62% of female participants know how to perform SBE, and only
59% ever performed BSE. The majority of women in the study (92%) would seek
medical advice if they discovered a mass in the breast whereas, about half of
those (59%) would consult a male doctor.
Conclusions: Women
participated in this study were fairly informed about BC risks and warning
signs; the results appear to reflect growing awareness of women regarding BC
screening methods. health education message should be presented and delivered
in a culturally-sensitive manner and tailored to provide simple and clear
information and avoid false beliefs and misconceptions about the disease, its
screening methods and management options.
Keywords: Breast cancer; Breast cancer
self-examination; awareness; Libya
Introduction
Breast cancer is the most common cancer
in women both in the developed and less developed world. It is estimated that
worldwide over 508 000 women died in 2011 due to breast cancer. Although breast
cancer is thought to be a disease of the developed world, almost 50% of breast
cancer cases and 58% of deaths occur in less developed countries [1]. Breast
cancer (BC) represents 10% of all cancers diagnosed annually and the second principal
cause of cancer deaths in women worldwide [2,3]. The incidence of new cases is
expected to rise from 10 million in 2002-15 million by 2025, with 60% of those
cases occurring in developing countries. Data from the Arab world have placed
breast cancer at the number one position with almost half of cases occurs in
women under the age of 50 [4]. In Libya, breast cancer is accounting for more
than 25% of all cancer in females with age-standardised mortality rate of 10.9
per 100,000 [5]. Breast cancer survival rates vary greatly worldwide, ranging
from 80% or over in North America, Sweden, Japan and Australia to around 60% in
Brazil and Slovakia and below 40% in Algeria [6].
The low survival rates in less developed
countries can be explained mainly by the lack of early detection programmes,
resulting in a high proportion of women presenting with late-stage disease, as
well as by the lack of adequate diagnosis and treatment facilities [1]. WHO
promotes breast cancer control within the context of comprehensive national
cancer control programmes that are integrated to non-communicable diseases and
other related problems. Comprehensive cancer control involves prevention, early
detection, diagnosis and treatment, rehabilitation and palliative care. Raising
general public awareness on the breast cancer problem and the mechanisms to
control as well as advocating for appropriate policies and programmes are key
strategies of population-based breast cancer control [1].
Screening and early detection is widely
recognized as being a principal factor in reducing the mortality from breast
cancer [7]. However, previous studies reported that most breast cancer patients
present at advanced stages of the disease which emphasise the need for
increasing awareness and improved screening programmes including
self-examination, clinical breast examination and mammography [8,9]. In 2011, a
comparison of the clinic-pathological and epidemiological features of breast
cancer in Libya to corresponding data from patients from Nigeria and Finland
has reported that approximately 51% of Libyan patients were classified in
stages 3 and 4 [10,11]. Also, research has shown poor levels of knowledge
towards risk factors awareness and screening methods even among young and
educated women [12-18].
Knowledge deficiency may lead to delayed
presentation with advanced stages when little or no benefit is derived from any
form of therapy. For presentation at an early stage, women must be “breast
aware”; they must be capable of identifying symptoms of BC through routine
practice of screening [19]. Assessment of the current level of breast cancer
awareness and knowledge toward risk factors and screening methods is crucial
for the development of awareness campaigns and programmes for women to decrease
the burden of the disease and mortality. Therefore, the study will be conducted
to assess the current level and determinants of knowledge and beliefs regarding
breast cancer, risk factors and various screening methods among Libyan women.
Materials and Methods
A cross-sectional descriptive study
carried out between September and October 2016 among a sample of adult women in
western Libya. Women participating in the study were interviewed using
pre-tested validated questionnaire. The questionnaire included 49 questions
pertaining three sections:
I. socio demographic characteristics of
women participating in the study;
.
II. knowledge of breast cancer risk
factors and warning signs;
III. Knowledge and awareness of women
towards breast cancer screening methods knowledge (BSE, CBE, and mammography).
Knowledge Scoring
The questionnaire consisted of 23 items
that assessed students’ knowledge related to breast cancer (13 questions related
to BC risk factors and 10 questions related to BC warning signs0 and 20 items
that assessed students’ knowledge regarding breast cancer screening methods.
These questions were then scored; each correct response was scored one (1)
point and each wrong or “don’t know” was scored zero (0). A correct response
was based on literature and current practice. The knowledge index was
calculated for each participant by summing the number of correct answers. The
total score of the participants’ knowledge regarding breast cancer is 23
(100%). The knowledge level was categorised as “low” for scores within 0-49%,
“moderate” for scores within 50-79% and “high” for scores within 80-100% [20].
These scores were then used to assess the relationship between socio-demographic
factors and level of breast cancer knowledge and warning signs.
Statistical Analysis
Data were translated to English and
analysed using SPSS version 17 (SPSS Inc., Chicago, IL). Descriptive statistics
including means, standard deviation, frequencies, and percentages were obtained
for all continues and categorical variables as appropriate. Chi-square test was
used to examine the association between the respondents’ socio-demographic
variables and knowledge of breast cancer.
Ethical Considerations: Permissions were
obtained from the local health directorate and prior orientation of
participants was carried out. The data collection tools were anonymous, and
data confidentiality was maintained throughout the study.
Results
The mean age of the 1091 women enrolled
in the study was 33.2 (SD 9.6; age range: 18-61) years. Most participants
(71.8%) were aged less than 40 years and there were 501 (45.8%) single
respondents; 463 (42.2) were students; 996 (79.6%) had a university degree and
930 (93.4%) had no family history of breast cancer (Table 1).
Table 1: Socio-demographic Characteristics of the
Participants.
Section A of Table 2 shows respondents’
knowledge of risk factors for breast cancer; The women surveyed had a fair
knowledge of BC risk factors; 565 (52.7%) of those surveyed were aware that
increasing age was associated with a higher incidence of breast cancer and 747
(68.3%) of the respondents identified positive family history as a risk factor
for breast cancer. However, only third of the participants answered correctly
about the effect of early menarche (31.9%) and late menopause (37.5%). The
majority of women participated in the study were aware of BC early warning
signs and symptoms with over 90% of the women were able to list at least one
symptom of breast cancer correctly. The most frequent warning sign identified
was breast lump (91.0 %), followed by discharge from the nipples (80.6%). Only
566 people (52.4%) acknowledged that weight loss could be a warning sign of
breast cancer (Table 2).
Table 2: knowledge regarding Breast cancer risk factors
and warning signs among study participants.
The results showed that 62% of female
participants know how to perform SBE, and only 59%% ever performed BSE. The
majority of women in the study (92%) would seek medical advice if they
discovered a mass in the breast, whereas, about half of those (59%) would
consult a male doctor. Regarding screening methods, women were more familiar
with BSE. Only 20% of participants were not aware of BSE, compared to 40% of
women who were not aware of ultrasound as a BC screening method. In total,
women who didn’t know any screening methods constituted only 4%. While, 45% of
women were familiar with the five screening methods [20].
Figure 1: Distribution of breast cancer risk factors and
warning signs knowledge scores.
Table 3: Relationship between knowledge scores and
demographic variables of the respondents.
Figure 1 shows the distribution of the
knowledge scores amongst the respondents. The median score was 15 with 782
(71.5%) of women scoring >50% and 240 (22%) had a good score of o 80% or
more. Age of the participants, marital status and their level of education did
play a significant role in determining the knowledge attitude, while positive
family history of breast cancer in a first degree relative as well as a history
of breast problem were not significantly associated with BC knowledge (Table
3). Almost 50% of those with good knowledge score aged between 26-35 years and
75% had a university degree. Whereas only 8% of participants with good
knowledge score had a positive family history breast cancer or a previous
breast problem.
Discussion
Breast cancer is the most common of all
female cancers in Libya [5]. In this study, the knowledge and practice among
general population in western Libya was explored. The main findings were that
level of awareness of risk factors and early warning signs of BC was moderate,
with 71.5 % having good knowledge, also the study showed that 59.2% of women
participated in the study perform BSE. The level of knowledge about breast
cancer and the screening behaviour is generally poor in Arabic region compared
to the developed world [6,10,17]. In the present study, respondents answered
correctly that the commonest symptom of breast cancer is a breast mass. Our
results are consistent with those of similar studies carried in Saudi Arabia
[21,22] and Kuwait [23].
The present study showed that women
demonstrated higher knowledge of breast cancer screening and risk factors and
were more likely to perform BSE compared to other recent studies in
neighbouring countries [24-26]. Similar to previous studies [23,25,27] the most
familiar methods was BSE followed by CBE and mammography. As it was expected,
satisfactory knowledge scores were more common among younger participants and
those with higher educational levels. However, unlike other studies in the
region [24-25] and worldwide [28], the anticipated fact that women who had a
breast problem or positive family history of BC would have better knowledge
scores could not be demonstrated in the present study. The study revealed that
about two thirds of the participants shared a misconception that early menarche
and late menopause were not risk factors for BC. This finding was supported by
a previous study [29].
The results of this study may be
influenced by the young age and the relatively high educational level of the
surveyed women which may reflect selection bias. A second limitation of the
current study is the use of convenience sampling to recruit participants which
may limit the generalisability of the findings. Nevertheless, convenience
sampling considered a valid data collection method and has been widely used in
health education research [30]. In spite of these limitations, the study
yielded significant findings that could have implications reorganise the
national health education strategy.
Conclusion
women participated in this study
were fairly informed about BC risks and warning signs; the results appear to
reflect growing awareness of women regarding BC screening methods. However,
health education message should be presented and delivered in a
culturally-sensitive manner and tailored to provide simple and clear
information and avoid false beliefs and misconceptions about the disease, its screening
methods and management options.
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