Chapter one
Introduction
1.1 Background to the Study

Breast cancer is the most common malignancy and first cause of cancer mortality in women worldwide with a world number of new cases estimated at 1,384,155 in 2008.[1] Its worldwide prevalence is still on the rise[2, 3] and nowadays breast cancer is considered to be an increasing public health problem among populations in low- and middle-income countries (LMICs). Moreover, a recent population-based study of cancer survival in Africa, Asia and Central America found unacceptably low breast cancer survival rates in African countries especially in Gambia where the 5-year age-standardized relative survival did not exceed 12%.[4]

Globally, breast cancer has been identified as a leading cause of death globally (1,2). There are more than a million new cases of breast cancer resulting in about 875,000 deaths each year, with high mortality rates in developing countries (3). In Nigeria, breast cancer has been reported to account for 56.6% of all cancer diagnosis between 1995&2002 (4). The burden of the disease has been on the increase and affected women often present late in hospitals when it has reached advance stage (5). Its cure at this stage becomes seriously compromised; the poor survival rate has been linked to late detection and diagnosis(6). Cancer is a disease process that begins when an abnormal cells is transformed by the genetic mutation of the cellular Deoxyribonuleic acids (DNA)(7). Breast cancer is neither painful nor cause any discomfort in its early stage. It usually present as a painless breast lump. There are diverse risk factors that may affect each woman's susceptibility to the disease(3).

Besides poverty, low public awareness of breast cancer is a barrier to breast cancer control in LMICs where women seek medical help late and cancers are often diagnosed at advanced stages when very little can be done in terms of curative treatment. The Breast Health Global Initiative (BHGI) panel[5, 6] has recommended implementation strategies to optimize breast cancer management in LMICs concerning health-care systems, breast cancer diagnosis, treatment and early detection. For early detection, efforts must be devoted to improve community awareness. Civil society, represented by non-governmental organizations (NGOs), can play an important role in breast cancer control.[7]

In Ghana, 2,062 new breast cancer cases and 1,137 breast cancer deaths were estimated annually (16.5% of all women cancer deaths), with age-standardized incidence and mortality rates of 25.8 and 15.2 per 100,000 women, respectively (Globocan 2008).[1] Sixty percent of cases were detected at late stages (IIB, III and IV).[8] The available data on median age are limited and mainly hospital based. Clegg-Lamptey et al. reported a median age at diagnosis of 43 years on a sample of 66 women newly diagnosed with breast cancer. The age range was broad, from 20 to 84 years.[8] Surgery still represents the main form of treatment for breast cancer in the country[9] and as in other African countries some cultural beliefs and mysticisms surround the disease.[10].

1.2 Problem Statement

To date, little research has been done regarding the impact of awareness programs in breast cancer control in Nigeria and even less at the community level in rural areas. hence there is need to assess the impact of breast cancer awareness programmes on the prevention of breast cancer amongst Nigerian women.

1.3 Objectives of the study

The major objective of the study is the impact of breast cancer awareness programmes on the prevention of breast cancer amongst Nigerian women.

1.4 Research questions

(1) what is breast cancer

(2) How can it be prevented?

(3) what effect does breast cancer awareness programmes have on the prevalence of breast cancer?

 1.5 Significance of the study

Our study aimed to assess the impact of breast cancer awareness programmes on the prevention of breast cancer amongst Nigerian women.

1.6 Scope of the study

The research focus on the impact of breast cancer awareness programmes on the prevention of breast cancer amongst Nigerian women.

References

1. Ferlay J, Shin HR, Bray F, et al. GLOBOCAN 2008, cancer incidence and mortality worldwide: IARC CancerBase No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer, 2010. Available at: http://globocan.iarc.fr (Accessed June 21, 2013).

2. Sasco AJ. Cancer and globalization. Biomed Pharmacother 2008;62:110–21.

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3. Forouzanfar MH, Foreman KJ, Delossantos AM, et al. Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis. Lancet 2011;378:1461–84.

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4. Sankaranarayanan R Swaminathan R, Brenner H, et al. Cancer survival in Africa, Asia, and Central America: a population-based study. Lancet Oncol 2010;11:165–73.

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5. Anderson BO, Cazap E, El Saghir NS, et al. Optimisation of breast cancer management in low-resource and middle-resource countries: executive summary of the Breast Health Global Initiative consensus, 2010. Lancet Oncol 2011;12:387–98.

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6. El Saghir NS, Adebamowo CA, Anderson BO, et al. Breast cancer management in low resource countries (LRCs): consensus statement from the Breast Health Global Initiative. Breast 2011;20:S3–S11.

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7. Azenha G, Bass LP, Caleffi M, et al. The role of breast cancer civil society in different resource settings. Breast 2011;20(Suppl 2):S81–S87.

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8. Clegg-Lamptey J, Dakubo J, Attobra YN. Why do breast cancer patients report late or abscond during treatment in Ghana? A pilot study. Ghana Med J 2009;43:127–31.

PubMed

9. Clegg-Lamptey J, Hodasi WM. A study of breast cancer in Korle-Bu teaching hospital: assessing the impact of health education. Ghana Med J 2007;41:73–7.

10.Okobia MN, Bunker CH, Okonofua FH, et al. Knowledge, attitude and practice of Nigerian women towards breast cancer: a cross-sectional study. World J Surg Oncol 2006;4:11.