Background to the study
Breast cancer (BCa) is a malignant tumour that has developed from breast cells, which has no cure at present. However, it can be managed with modern technological tools, and one’s life can be prolonged. In the last four decades, with the introduction of screening programmes that efficiently detect cervical cancer in its early stage, BCa has been seen to overtake cervical cancer in incidence and has become number one neoplasm among women (Okolie, 2012). BCa has therefore become a worldwide major health problem. The vast majority of it occur invasively in women (National Cancer Society [NCS], 2013). It accounts for 16% of all female cancers, and 22% of it are invasive. In both men and women, it accounts for 18.2% of all cancer deaths (NCS, 2013). Adebamowo and Ajayi (2006) corroborate the opinion of NCS and maintain that BCa is the commonest cancer among women in the world and in Nigeria too.
Adebamowo and Ajayi (2006) opine that it has become the commonest malignancy affecting Nigerian women. Also, according to Smeltzer, Bare, Hinkle and Cheever (2010), among the ten leading types of cancers by gender determined on the basis of estimated new cases and deaths in the United States in 2004, BCa accounts for 32% and the highest in female while prostate cancer accounts for 33% in males, which is the highest among them. Some of its common threats to physical wellbeing according to Adejumo and Adejumo (2009) include effects of treatments, recurrence and metastasis, fatigue, arm and shoulder discomfort, as well as lymphedema.
Unfortunately, Nigeria (which is the home country of the reverend sisters that are the focus of this study) remains ill-equipped to deal with the complexities of cancer detection and care as the testing and care facilities are still very few. The prevalence of BCa within the country is 116 per 100,000, and 27,840 new cases were expected to develop in 1999 (Adebamowo & Ajayi, 2006). In 2005, between 7 and 10,000 new cases of BCa developed.
This increasing incidence of BCa in Nigeria is in line with the situations in other developing countries, and even those advanced countries that used to have a low incidence now record high incidence. The relative frequencies of BCa among other female cancers, from Cancer Registries in Nigeria were 35.3% in Ibadan, 28.2% in Ife-Ijesha, 44.5% in Enugu, 17% in Eruwa, 37.5% in Lagos, 20.5% in Zaria and 29.8% in Calabar (Banjo, 2004 ). Similarly, in all the centres, except Calabar and Eruwa, BCa rated first among other cancers.
Further reports showed that majority of cases occurred in premenopausal women, and the mean age of occurrence ranged between 43–50 years across the regions. The youngest age recorded was 16 years, from Lagos (Banjo, 2004). This trend was attributed to several factors such as: the acceptance of fine needle aspiration as an accurate diagnostic evaluation, and increased awareness about BCa and usefulness of breast self-examination (Thomas, 2000).
Several other factors are responsible for this increasing detection, but the most important in the researcher’s view are: increased access to diagnostic facilities;empowerment of women, which is increasing women’s ability to make independent decisions about their own health-care; increasing westernization of dietary products;and physical activity; obstetric and gynaecological factors among others. Conventionally, breast self-examination (BSE) is the easiest and simplest procedure for detecting breast masses because a woman who knows the texture, contour, and feel of her own breasts is far more likely to detect changes that may develop (ACS, 2007).
The above notwithstanding, the American Cancer Society (2010) made the following recommendations: monthly self breast examination (SBE) beginning at the age of 20, from the fifth day of the menstrual cycle to one week following menstruation; clinical breast examination every three (3) years, from age 20 to 40, then annually, beginning at age 40; and mammogram, at age 40, and above annually. Adejumo and Adejumo (2009) recommend that in addition to the above promotive health behaviours, needle aspiration may be performed when ultrasound reveals a suspicious lesion. The researchers advanced that imaging techniques offer new and emerging technologies that aid diagnosis of the disease at its rudimentary stage.
Anecdotal knowledge and experience have revealed that the knowledge of preventive and promotive health behaviours of reverend sisters is highly militated against, probably owing to their life-style, ignorance and fear on their part, and inability of the health team to create adequate awareness. This, may lead to increase in the rate of high sisters mortality, sequel to BCa, as evidenced by the number of deaths (7), recorded by the congregations, which occurred in quick succession. Such deaths would have been averted if the sisters were responsive to preventive health behaviours of early BCa detection practices. Moreover, early detection of BCa will lead to early intervention at an early phase of cancer progression, resulting in improvement in years of survival for the clients/sisters.
There are two categories of reverend sisters, the contemplatives and the active ones. The active reverend sisters are the sisters that live in convents from where they interact and operate with the outside world, committing themselves to some hours of private and community prayers. The conservatives are popularly known as nuns who live in monasteries and take vow of stability, in addition to the vows of chastity, poverty and obedience. They live strict life of enclosure.
There is an urgent need to assess the knowledge of BCa and its preventive health behaviours among the different congregations for early detection and prompt intervention, so as to avert deaths sequel to its occurrence. Okolie (2012) maintains that BCa is now a manageable disease, and attributes this to early diagnosis and advances in surgical techniques, chemotherapy and radiation, with the main thrust being, early diagnosis. The reverend sisters therefore have a role to play in diagnosis by performing monthly breast self examination (BSE), obtaining routine screening, via mammography and seeing a health professional for regular breast examinations, as well as going for ultrasound (though secondary), in order that BCa could be detected early enough for prompt intervention/s, given their nulliparous nature. The researcher’s concern is basically to find out what reverend sisters in Anambra State know about BCa and what they do towards its early detection.
BCa is ranked the second most frequent to cervical cancer in Africa, and Nigeria has a double rise in the incidence (Adejumo & Adejumo, 2009). Taire (2010) estimates that between 7,000 and 10,000 new cases were detected in Nigeria in 2005, and that BCa caused 502,000 deaths (7% all of cancer deaths; almost 1% of all deaths) worldwide the same year.According to WHO (2005) report in Nigeria, approximately 89,000 people died from cancer in 2005, and 54,000 of them were under the age of 70.
Anecdotal information based on observation has revealed an alarming trend in incidence of BCa among reverend sisters, with high morbidity and mortality rates. In the three hospitals commonly used by these sisters, there have been records of many sisters with the complaints of breast changes–tenderness, irregularities in size and contour, shrinking, irregular swelling, visible veins, retraction of the nipple(s), and/or discharges from the breast, between May, 2011 and October, 2013, and who were diagnosed of BCa in their various stages. On the 16th of September, 2013, an 82 year old sister died of BCa, and in the first quarter of 2012, another sister was said to have died of BCa. Between, August, 2012, and October, 2013, three had unilateral masectomy, and even back in 2010 and 2013, two sisters from the same congregation died of BCa. Retrogressively still, in the years, 2013, 2012; 2011; 2006; 2001; 1983; 1978; and 1977, sisters were lost to BCa (Location, 2013). Currently, two sisters from the researcher’s community are receiving BCa treatment.
Some other congregations are experiencing similar plight as they have recorded over six (6) deaths sequel to BCa within a space of three years, 2005 to 2013. For instance, the agonizing death of a thirty eight (38) year old sister recorded in April, 2012 by Daughters of Mary Mother of Mercy (DMMM), in Ahiaeke Umuahia; and that from Handmaids of the Holy Child Jesus(HHCJ) who died in April, 2013 in Ikot Ekpene, aged forty eight (48) years. This rising incidence of BCa can be attributable to the characteristics of the reverend sisters with uncompromising modesty and the tendency to endure pains and discomforts for the higher goal of supernatural benefits. One wonders if this aspect of their sacrificial life is worth the price paid. The non-compliance to annual check- ups and undue modesty of most of them could all be contributory factors to the above anomaly. Most of the cases were detected through routine clinical breast examination, as the sisters fall within the category of professionals socialized into high tolerance for discomforts, including pains. At times, this works against them because pains which are obvious indicators of BCa, and which would have compelled one for early detection of the disorder is glossed over, giving rise to late detection of BCa. Where the culture of pondering things over in one’s heart without complaining prevails, there is need for greater emphasis for early detection of diseases, including BCa, through BSE; CBE; and mammography.
It is against the above backdrop therefore, and given the fact that the researcher, as a reverend sister living in the convent, is directly involved, and feeling very uncomfortable with the prevailing situation, the researcher was spurred to embark on this study, so as to bridge the existing gap and consequently promote positive healthful living among the sisters.
Purpose of the study
The main purpose of the study is to assess the knowledge of BCa and early detection measures among reverend sisters in Anambra state. The specific objectives include to:
- Ascertain what the reverend sisters know as breast cancer.
- Ascertain what they attribute as causes/risk factors of breast cancer.
- Identify the reverend sisters knowledge of BCa early warning signs.
- Ascertain what the reverend sisters know as early detection measures of breast cancer.
- Ascertain how BCa can be prevented as perceived by the sisters.
- Identify reverend sisters’ sources of knowledge on BCa.
- Find out how reverend sisters practice early breast cancer detectionmeasures.
- Identify the factors that militate against their practiceof early detection measures
The following research questions guided the study:
1) What do the reverend sisters know about BCa?
2) What do reverend sisters attribute as causes/risk factors of breast cancer?
3) What are the warning signs of BCa as perceived by the reverend sisters?
4) What are the early detection measures of breast cancer the reverend sisters know?
5)How can BCa be prevented as perceived by the reverend sisters?
6) What are the reverend sisters’ sources of knowledge on BCa?
7)How do reverend sisters practice early breast cancer detection measures?
8) What are the factors that militate against the respondents practice of BCa early detection measures?
Significance of the study
BCa has become the commonest cancer affecting women world-wide. The findings of the study will inevitably benefit many persons and groups of people. These include: all reverend sisters; local and regional administration; Superiors General; Medical Advisory Councils of the various congregations; National Association of Nigerian Religious Women; health institutions, staff and student nurses/midwives, as well as medical students at large.
Findings of this study will help provide information on how much knowledge of BCa and appropriate health behaviours the sisters exhibit, and generate valid data for adequate assessment of the sisters on the subject matter. The feedback value of the study will help in making modifications where they are deficient. The implications of the study will serve as a guide for self-monitoring of both the sisters and prospective candidates into the sisterhood within the state and beyond. It will give insight into the attitude of some sisters towards breast- self examination, and also reveal the reason/s why some detest examination of the breast by health providers.
The findings will equally help design acceptable health promotion/awareness programmes about BCa. Thus, informing in-service training programmes so that the incumbent and aspiring sisters can learn and imbibe the skills in BSE and the disposition to avail oneself of the other detection practices well in advance. The result of the study therefore will guide the authority of the congregations on how to develop, structure and organize workshop programmes on BCa in order to derive maximum benefit for the various categories of sisters in the state. It will also sensitize the formators and formatees in all formation houses on the need to organize programmes in their day to day examination of their breasts..
More importantly, the Central administration of each Order may be compelled to review downwardly, their yearly intake of candidates in order to guarantee adequate holistic care of each sister.The study finding will add to the already existing body of knowledge, contributing to new knowledge to Nursing Profession, it will provide empirical data on the level of knowledge of religious women aged 20 to 70 years, and more. This study may provide evidence for the requirement of established National Screening Program for BCa in the future.
Scope of the study
The study is delimited to assessing the knowledge level and early detection health behaviours practiced by reverend sisters in Anambra State, towards BCa, as well as the factors militating against the sisters practice of early detection measures of BCa.
Operational definition of terms
Early detection practices: The actions subjects take towards early identification of signs of BCa, such as breast self examination, clinical breast examination, and mammography. How often breast self examination could be done, when, how and what to look for using appropriate skills.
Knowledge of BCa: Ability of the subjects to know the meaning of BCa, risk factors/causes, early signs, their sources of information, and the factors that influence their practice of BSE.
Reverend Sisters:Consecrated Catholic women who devote their lives to the service of God and humanity by living a vowed prayer lives in communities and monasteries. Active reverend sisters: These are the sisters that live in convents from where they interact and operate with the outside world, committing themselves to some hours of private and community prayers.
Conservative reverend sisters: The conservatives are popularly known as nuns who live in monasteries and take vow of stability,in addition to the vows of chastity, poverty and obedience. They live strict life of enclosure.