Breast Cancer Screening In Nigeria: Evaluating Practices, Barriers, And Prospects

Abstract

Background: Breast cancer incidence in low and middle income countries continues to rise while outcomes remain poor. Early detection through screening has been recognized as an important factor for improving outcomes. Currently, there are no organized breast cancer screening programs in most low and middle income countries, Nigeria inclusive. In designing one, it is imperative to understand current screening practices, and barriers to screening. Also important, is the need to evaluate the prospects of a screening program given the limited resource capability and the possible impact of socio-cultural factors on the uptake of screening. Methods: Women, 40 years and older in Ife central and Iwo local governments in South-western Nigeria were surveyed. Ife central has a Teaching Hospital which offers mammography services while Iwo which is 32 miles away does not. Interviewers administered a 35 item questionnaire to assess socio-demographic information, breast cancer knowledge, mammography screening practices, reasons for not undergoing mammography and ability to pay for mammography. In addition, screening practices in the two communities were compared to assess the impact of access on uptake. As an initial step the prospects of a CBE based screening program in Ife-Central local Government was assessed. CBE practice as well as perceptions and preferences were evaluated. Results: 2222 women were interviewed, 1169(52.6%) in Ife and 1053(47.4%) in Iwo, most between ages 40-49 years. The majority had heard of breast cancer (Ife 94%, Iwo 97%), but few were aware of mammography as a breast cancer screening tool (Ife 11.8%, Iwo 11.4%). Mammography uptake in Ife was 2.8% and 1.8% in Iwo, despite Ife having mammography services geographically accessible and 20% reporting they could afford annual mammography at the present cost. Knowledge and practice of mammography were not statistically different between the two communities (p= 0.74, 0.1). Lack of awareness was the reason for not undergoing mammography in the majority while only 20% reported they could afford annual mammography from both communities. Of the 1169 women in Ife, only 19.7% have had a CBE, of which only 6% had it in the last year. The majority (65.4%), were willing to have regular clinical breast examination and did not care about the gender of the examiner in most instances. Lack of perceived need was the reason cited by women unwilling to participate. Conclusion: Mammography screening practices are generally poor in spite of geographic access. Lack of awareness was cited as the principal barrier to screening, while cost may also be a potential limiting factor for many who are willing. With the majority willing to have regular CBE, a carefully designed CBE program coupled with advocacy to correct uneducated beliefs seems promising.