Innovative Journal of Medical and Health Science

Received 15 Aug 2020 | Accepted 27 Sep 2020 | Published Online 17 Oct 2020

DOI: https://doi.org/ttps://doi.org/10.15520/ijmhs.v10i10.3119
I Jour Med Health Science 10 (10), 1332−1345 (2020) ISSN (O) 2589-9341 | (P) 2589-9341 IF:1.6

ORIGINAL ARTICLE

Knowledge of Breast Cancer Risk Factors and Practices of Breast

Self-Examination among Women in Northern Ghana

Alexis Dun Bo-Ib Buunaaim1 Waliu Jawula Salisu2 Hawawu Hussein3

∗

Yempabe Tolgou4 Stephen Tabiri5

1
Trauma and Orthopedics Unit, Abstract
Tamale Teaching Hospital, Introduction: Breast cancer remains a major global health concern in
Tamale, Ghana and Department
both developed and developing countries. The current study aimed to
of Surgery, School of Medicine and
Health Sciences, University for assess the knowledge of breast cancer (BC) and the practice of breast
Development Studies, Tamale, self-examination (BSE) among females in the Tamale Metropolis of
Ghana Northern Ghana. Methods: This is a cross-sectional study involving
2
Department of Nursing, Tamale 1122 participants; consisting of nurses 157 (14.1%), teachers 227
Teaching Hospital, Tamale, (20.2%), undergraduate university students 339 (30.5%), medical
Ghana students 95 (8.5%) and market women 304 (27.3%). Using a
3
Department of Research and convenience sampling method to select the participants, we distributed
Development, Tamale Teaching questionnaires to participants; all were completed and returned.
Hospital, Ghana
Results: Most of the participants, 498 (44.4%), were between 19-25
4
Trauma and Orthopedics Unit, years of age. The majority were enlightened about BC (93.1%) and
Tamale Teaching Hospital,
BSE (87.6%), 723 (64%) had good knowledge about the risk factors of
Tamale, Ghana
BC. A total of 857 (76.4%) had previously been taught BSE. However,
5
Department of Surgery, School of only 417 (37.2%) were found to practice BSE regularly. Conclusion:
Medicine and Health Sciences,
University for Development The knowledge of BC risk factors and BSE was remarkable but varied
Studies, Tamale, Ghana and in the various occupational categories. However, only a few
Associate Professor of Surgery, participants practiced BSE regularly. There is a need for widespread
Department of Surgery, educational campaigns to educate further and encourage women to
University for Development
Studies-School of Medicine and practice BSE regularly. The inclusion of men in these crusades is long
Health Sciences and Tamale overdue. Equipped with BSE's knowledge and skills, men could assist
Teaching Hospital, Tamale, and encourage their spouses to frequently examine themselves. Further
Ghana research studies will be necessary to ascertain the role of men in
championing BSE.
Supplementary Keywords: awareness, breast cancer, breast self-examination, knowl-
information The online edge, practice, Ghana, Tamale
version of this article(https://
doi.org/10.15520/ Corresponding Author: Alexis Dun Bo-Ib Buu-naaim
ijmhs.v10i10.3119 Trauma and Orthopedics Unit, Tamale Teach-ing Hospital,
contains supplementary Tamale, Ghana and Department of Surgery, School of Medicine
material, which is available to and Health Sciences, University for Development Studies, Tamale,
authorized users. Ghana Email: [email protected].
I Jour Med Health Science 10 (10), 1332−1345 INNOVATIVE JOURNAL 1332
KNOWLEDGE OF BREAST CANCER RISK FACTORS AND PRACTICES OF BREAST
SELF-EXAMINATION AMONG WOMEN IN NORTHERN GHANA

imaging, and mammography are often used to

INTRODUCTION
screen for breast cancer [9].
Breast cancer remains a major global health
Owing to the lack of access to health care
concern in both developed and developing
facilities and the high cost associated with
countries [1,2]. It is currently the world's most
advanced screening methods, the BSE is
common cancer and the leading cause of cancer
recommended for women in low-resourced
deaths among women. In 2018 alone, it
areas [4,10]. Even though it is not the most
accounted for 11.6% (2,088,849) of all new
preferred test in early detection of breast
cancer cases and 6.6% (626,679) of cancer
cancer[11], BSE benefits women in knowing
deaths globally [3].
their breast's natural physical characteristics to
The incidence of breast cancer in low and identify any abnormal changes when they occur
middle-income countries (LMICs) such as quickly. Both the American Cancer Society and
Ghana is on the rise and has recently accounted the Canadian Cancer Society recommends that
for most cancer deaths in these areas (1). Poor women be familiar with their breast's typical
health infrastructure, lack of awareness, among nature and report any changes to health care
others, have been cited as some challenges providers as soon as possible [11,12].
accountable for the high mortalities in Africa
However, the BSE method seems not to be
[4,5].
commonly practiced among most women since
Even though it is widely reported that the delayed breast cancer presentations remain a
success rate of the treatment of breast cancer problem.
increases with early detection and treatment
This current study, therefore, aims to assess the
[6], delayed presentations are rampant, owing
knowledge of breast cancer risk factors and the
to personal factors [7], and in some cases,
attitudes of participants towards the practice of
health system delays [8].
breast self-examination among a subgroup of
The breast's physical characteristics make women in the Tamale Metropolis of Northern
breast cancer a few cancers that are easy to Ghana.
detect during its early development [2] through
To our knowledge, no data have so far been
inexpensive methods such as breast self-
published on this subject in our local setting
examination (BSE). This method does not
comprising such a heterogeneous population.
require any medical equipment or the
The findings will serve as a basis for
involvement of a professional medical
comparisons in similar settings and inform
practitioner. However, it guarantees early
policies directed at reducing the delay in breast
detection of potentially dangerous breast
cancer BC presentation at hospitals and
lesions and empowers women to feel in control
educating the public about BSE.
of their health, although a primary screening
method. BSE can be practiced routinely by any
woman who was taught how to and willing to
METHODS
do it.
The current study was a cross-sectional
A side from the BSE, other methods such as descriptive study conducted in Tamale
breast ultrasound, clinical breast examinations Metropolis using a convenience sampling
by a health professional, magnetic resonance method. Tamale is located in the northern part
of Ghana and currently the largest city in the

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entire area. Both the knowledge of BC's risk factors and

The participants were recruited using a BSE's good practice were categorized into poor
convenience sampling method in each of the and good. A score of 7.9 or less was classified
population groups that were studied. The nurses as poor and greater than or equal to 8 was good
and medical students who participated were knowledge. The total score for knowledge was
selected from the only teaching hospital in the 13. The highest score for practice was 6, the
area — the teachers from four different score for poor practice was 2.39, and for Good
schools. The university students were selected practice greater or equal to 2.4.
from a single school and the market women The data were entered into SPSS (SPSS Inc.,
from one of the metropolis' main markets. Chicago, US) version 22 for analysis.
A questionnaire was designed based on Descriptive statistics were used to present data
previous literature and pretested on twenty-five in percentages and frequencies. A univariate
nurses and medical students. A few and multivariate logistic regression was used to
modifications were made to the questionnaire determine predictors of the knowledge of BC's
after the pretest before it was used for the data risk factors and the practice of BSE among the
collection. The questionnaire sought participants. A p-value of less than 0.05 was
participants' demographic data, their considered statistically significant in all tests.
knowledge and awareness of BC's risk factors,
and the knowledge of BSE's good practice
attitude. RESULTS

The data collection was conducted from May Participant's Demographic Characteristics
2017 to August 2017. We obtained ethical A total of 1122 participants consisting of nurses
approval from the ethical review committee of 157 (14.1%), teachers 227 (20.2%),
Tamale Teaching Hospital, Ghana. Approval undergraduate university students 339 (30.5%),
ID number TTHERC/17/11/16/05. Further medical students 95 (8.5%) and market women
permission was obtained from the various 304 (27.3%) in Tamale metropolis. Of the total
institutions that the data collection was to be number, 498 (44.4%) were between age 19-25,
conducted. with those aged 37-50 being the least, 147
Before the commencement of the data (13.1%). About 612 (54.5%) of the respondents
collection, we informed the participants about were single, 435 (38.7%) married, and 3 (0.3%)
the objectives of the study. Both verbal and of respondents were co-habiting. A total of 447
written consent was obtained from each (40.9%) and 87 (8%) of respondents were
participant. Participants should be female, Orthodox and Ahmadis Muslims, respectively.
aged 19 years and above, and without BC to be Also, there were 193 (17.7%) members of
included in this study. Females less than the set Catholic, 147 (13.4%) Pentecost, and 147
age criteria and with any type of breast disease (13.4%) Charismatic Christians (Table 1).
were excluded.

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SELF-EXAMINATION AMONG WOMEN IN NORTHERN GHANA

Table 1: Descriptive characteristic of participants

Variable Frequency Percentage

AGE
19-25 498 44.4
26-36 271 24.2
37-50 147 13.1
>50 206 18.4
Total 1122 100
MARITAL STATUS
Single 612 54.5
Married 435 38.8
Divorce 22 2.0
Widow 38 3.4
Co-habiting 3 0.3
Total 1110 99
RELIGION
Orthodox Muslim 447 40.9
Ahmadis Muslims 87 8
Christian Catholic 193 17.7
Christian- Pentecostal 147 13.4
Christian-Charismatic 147 13.4
Other 72 6.6
Total 1093 100
OCCUPATION
Teachers 227 20.2
Nurses 157 14.0
Medical student 95 8.5
University Students 339 30.2
Market women 304 27.1
Total 1122 100.0

Awareness
BC
Regarding the Awareness of BC, 1045 (93.1%) participants, followed by schools 501 (24.3%),
of the respondents had heard of BC, while the hospital 398 (19.3%), friends 285 (13.8%) and
remaining 75 (6.7%) indicated they had never churches/mosques 74 (3.6%). The remaining 29
heard about it. (1.4%) indicated they did not know or cannot
remember where they first heard about BC
The mass media was the primary source of
(Table 2).
information to most 774 (37.6%) of the

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Table 2: Awareness of breast cancer

HAVE YOU EVER HEARD OF BREAST CANCER
Frequency
Percentage
1045 93.1
Yes
75 6.7
No
WHERE DID YOU HEAR OF BREAST CANCER
Do not Know 29 1.4
From Hospital 398 19.3
A Friend 285 13.8
Mass Media 774 37.6
Church/Mosque 74 3.6
School 501 24.3
Total 2061 (includes multiple responses) 100
BSE
For the awareness of BSE, 983 (87.6%) had source of information to most 603 (32.3%) of
prior knowledge, while 17 (1.5%) were unsure. the participants, while churches/mosques were
Again, the mass media was the dominant the least 113 (6.1%) (Table 3).
Table 3: General knowledge of breast self-examination

HAVE YOU HEARD OF BREAST SELF EXAMINATION

Frequency Percentage
Not Sure 17 1.5
Yes 983 87.6
No 121 10.8
Total 1121 99.9
IF YES, WHERE DID YOU HEAR OF IT
Hospital 433 23.2
Radio/Station 603 32.3
Church/Mosque 113 6.1
School 570 30.6
No Response 147 7.9
Total 1866 100
EVER BEEN TAUGHT HOW TO PERFORM BREAST SELF EXAMINATION
Do not Know 23 2
Yes 857 76.4
No 241 21.5
Total 1121 99.9
IF YES, WHO TAUGHT YOU
Doctor 250 18.7
Nurse 371 27.7
Teacher 228 17
Friend 127 9.5
Mass Media 363 27.1
Total 1339 100

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We applied logistic regression to estimate the against the knowledge of the practice of BSE
independent and combined effects of (Table 4).
predictors, including age and occupation,
Table 4: Logistic regression of age and occupation against the knowledge of the practice of
breast self-examination
Practice Level

Variable Poor N (%) High N Crude OR (95% P-value Adjusted OR P-value

(%) CI) (95% CI)

19-25 288(57.8) 210 (42.2) 1.00 1.00

Age

26-36 152(56.1) 119 (43.9) 3.4 (2.3-5.13) 0.000 1.7 (1.2-2.5) 0.05

37-50 95 (64.6) 52 (35.4) 3.7 (2.4-5.7) 0.000 1.6 (0.97-2.5) 0.065

>50 170 (82.5) 36 (17.5) 2.6 (1.6-4.2) 0.000 0.38 (0.24-0.6) 0.000

Occupation Teachers 146(67.3) 71 (32.7) 1.00 1.00

Nurses 64 (40.8) 93(59.2) 2.9 (1.9-4.6) 0.000 2.7 (1.7-4.4) 0.000

Medical 65 (68.4) 30 (31.6) 0.95 (0.6-1.6) 0.843 1.0 (0.56-1.8) 0.982

students

University 181 158 1.79 (1.3-2.6) 0.001 1.87 (1.19- 0.006

students (53.4) (46.6) 2.9)

Market women 243 (80) 61 (20) 0.5 (0.35-0.77) 0.001 0.4 (0.26-0.61) 0.000

In the Univariate analysis across all levels, the those aged 19-25. Except for >50 years of age,
age group was significant. Women of ages 26- the rest of the age groups maintained
36, 37-50, and >50 had about 2.3, 1.8, and 1.7 significance in the multiple regression model
times more likely to be knowledgeable about (Table.5).
the risk factors of breast cancer compared to

Table 5: Logistic regression of demographics against the knowledge of risk factors of breast
cancer

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Knowledge Level
Variable Poor N (%) High N Crude OR P-value Adjusted OR P-value
(%) (95% CI) (95% CI)
19-25 150(30.1) 348(69.9) 1.00 1.00

26-36 94 (34.7) 177(65.3) 2.3 (1.6 –3.2) 0.000 1.7(1.1 – 2.5) 0.01

Age
37-50 53 (36.1) 94 (63.9) 1.8 (1.3- 2.6) 0.001 1.9 (1.2-3.2) 0.005

>50
102(49.5) 104 (50.5) 1.7 (1.1-2.7) 0.012 0.9(0.64 – 1.47) 0.894

Occupation Teachers 138(63.6) 79 (36.4) 1.00 1.00

Nurses 40 (25.5) 117 (74.5) 0.32(0.2-0.5) 0.000 5.5 (3.3-92) 0.000
Medical student 24 (25.3) 71 (74.7) 1.64 (1.1-2.5) 0.025 6.6 (3.6-12.3) 0.000
University student 85 (25.1) 254 (74.9) 1.65 (0.9- 2.8) 0.057 6.3 (3.9-10.1) 0.000
Market woman 109(35.9) 195 (64.1) 1.67 (1.2-2.3) 0.003 3.2 (2.2-4.8) 0.000

Religion Orthodox Muslim 184(41.2) 263 (58.8) 1.00 1.00

Ahmadis Muslim 40(46.0) 47 (54.0) 0.38(0.21-0.69) 0.01 0.90 (0.56-1.5) 0.679
Christian Catholic 61 (31.6) 132 (68.4) 0.31(0.15-0.63) 0.01 1.3 (0.8-1.9) 0.266
Christian Pentecost 51(34.2) 96 (65.3) 0.57 (0.30-1.1) 0.08 0.9(0.64-1.5) 0.949
Christian 37 (25.2) 110 (74.8) 0.49(0.26-0.96) 0.038 1.6 (0.98-2.4 0.059
Charismatic
Others 15 (20.8) 57 (79.9) 0.8(0.39-1.5) 0.48 2.3(1.2-4.3) 0.01

Marital status Single 180(29.4) 432(70.6) 1.00 - -

Married 188(43.2) 247(56.8) 1.2 (0.1-13.3) 0.88 - -
Divorce 6 (27.3) 16 (72.7) 0.66(0.1-7.3) 0.73 - -

Widow 20 (52.6) 18 (47.4) 1.33 (0.1-17.6) 0.83 - -

Co-habiting 1 (33.) 2 (66.7) 0.45 (0.04-5.4) 0.52 - -

Knowledge
BC risk factors old age, 52.4% did not agree that the birth of a
first child after age 30 is a risk factor. Also,
Among the participants, 723 (64%) had good
most (57.4%) of the participants disagreed that
knowledge of BC's risk factors (Table 6). Nine
the early onset of menarche is a risk factor, the
out thirteen questions (69%) regarding
majority (49.5%) believe that the late start of
knowledge of BC were answered correctly
menopause is not a risk factor of BC.
(Table 7). Of the wrongly answered questions,
69.1% did not agree that BC is associated with

Table 6: Knowledge of risk factors of breast cancer and the attitudes and practices of breast self-
examination

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SELF-EXAMINATION AMONG WOMEN IN NORTHERN GHANA

Knowledge of risk factors of BC Frequency Percentage

Poor knowledge of risk factors 399 35.6
Good Knowledge of risk factors 723 64.4
Practice of BSE
Poor knowledge of the Practice of BSE 705 62.8
Good knowledge of the practice of BSE 417 37.2

Table 7: Knowledge of risk factors of breast cancer

Question Frequency Percentage
Breast cancer affects only women
Do not Know 25 2.2
TRUE 714 63.6
FALSE 382 34
Breast cancer can be transmitted by sexual contact
Do not Know 20 1.8
TRUE 75 6.7
FALSE 1026 91.4
Positive family history of breast cancer is a risk factor
Do not Know 45 4
TRUE 782 69.7
FALSE 294 26.2
Breast cancer is commonly associated with old age
Do not Know 25 2.2
TRUE 321 28.6
FALSE 775 69.1
Births of a first child after 30 years is a risk factor
Do not Know 76 6.8
TRUE 457 40.7
FALSE 588 52.4
Early-onset of menses, i.e., before 12 years
Do not Know 62 5.5
TRUE 415 37
FALSE 644 57.4
Late-onset of menopause after age 55 years
Do not Know 76 6.8
TRUE 490 43.7
FALSE 555 49.5

Being a woman is a risk factor

Do not Know 21 1.9
TRUE 904 80.6
FALSE 196 17.5

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Cigarette smoking is a risk factor

Do not Know 54 4.8
TRUE 850 75.8
FALSE 217 19.3

The eating of a low-fat diet is a risk factor

Do not Know 83 7.4
TRUE 187 16.7
FALSE 851 75.8
Exposure to radiation is a risk factor
Do not Know 45 4
TRUE 934 83.2
FALSE 142 12.7
The use of oral contraceptives is a risk factor
Do not Know 48 4.3
TRUE 562 50.1
FALSE 510 45.5
Regular sexual activities increase the risk of breast cancer
Do not Know 49 4.4
TRUE 165 14.7
FALSE 906 80.8

BSE 384(34.2%) never performed it. A good

When asked whether the participants had ever number 293 (41%) of the respondents reported
received any BSE training, 857 (76.4%) agreed that they performed BSE only when they feel
they had ever been taught to perform BSE. In like doing so, while 30 (4.2%) said they
comparison, 241 (21.5%) answered no. Nurses performed it every six months.
taught most 371 (27.7%) of the participants Across all age groups, the practice increased
how to perform BSE, followed closely by the with increasing reproductive age. Women
mass media 363 (27.1%). A good number 464 within the age groups of 26-36 and 37-50 each
(41.4%) of the respondents knew that BSE had about a 200% increase in BSE practice
should be performed right after menstruation, knowledge than 19-25, while it decreased after
whereas 172 (15.3%) did not know when to, 36 50 years. In the multiple regression model, age
(3.2%) answered BSE should be performed groups 26-36 and 37-50 maintained marginal
during menstruation. significance. Additionally, except for being a
medical student with no significance, all other
Practice of BSE
participants' groups were significant. Thus,
Of the entire study population, only 417 while the nurses were 2.9 times more likely to
(37.2%) had a good knowledge of the practice practice BSE compared to the teachers, the
of BSE (Table 6). university students will practice BSE 1.7 times
Most of the participants, 714 (63.3%), had ever compared to teachers. However, market women
performed BSE themselves, whereas practice BSE 0.5 times or 50% less than

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 KNOWLEDGE OF BREAST CANCER RISK FACTORS AND PRACTICES OF BREAST
SELF-EXAMINATION AMONG WOMEN IN NORTHERN GHANA

teachers. The significance declined marginally updated regarding health information.

in the multiple regression models (Table 5). However, this finding could also be due to bias
resulting from the medical students' sample
size. The students were mostly preclinical
DISCUSSION students who do not know clinical problems
This current study assessed the knowledge of like breast cancer, just like any other
BC's risk factors and the practice of breast self- undergraduate student. Studies have previously
examination among some groups of female demonstrated a possible link between the
Ghanaians, namely; Nurses, teachers, knowledge of BC risk factors and
undergraduate university students, medical professionalism [15]. In their research, Ibrahim
students, and market women. and Odusanya reported that female medical
doctors' mean score of BC knowledge was
In general, most of the participants reported
74%, while other professionals like nurses and
that they had prior knowledge about BC's risk
allied health professionals scored 35% and
factors. This finding is similar to previous
31%, respectively. This vast difference was
studies [13,14], unlike others that reported poor
mainly attributed to the participants'
knowledge of the risk factors of BC in parts of
professional affiliation, posited by the
Nigeria [15,16] and Egypt [17]
researchers [15].
The participant's knowledge of BC's risk
The awareness of BSE among the participants
factors was impressive; 69 % of the thirteen
in this study was widespread, with 87% of the
risk factor questions were answered correctly.
study participants having prior knowledge of
This finding is contrary to that of a similar
BSE. High awareness of BSE has previously
study conducted in Ghana [18] and Sri Lanka
been reported by studies conducted in Malaysia
[19], yet congruent with studies conducted in
[22], Palestine [23], Ethiopia [24], and Nigeria
Uganda [20] and Poland [21].
[25], whereas other studies conducted in
Breast cancer is a significant public health Turkey [26] reported low Awareness.
concern. It is not surprising, however, that most
The mass media was the primary source of
participants were well informed about the
information for most participants, as earlier
disease. The vast Awareness of BC could mean
reported by previous studies [17,23]. The mass
that participants are more likely to seek early
media can be a useful tool in educating the
treatment upon noticing BC's first signs.
public on public health concerns and should,
Therefore it would be of great benefit to the
therefore, be explored and used to the general
public if over 95% of the study population is
public's advantage. The ministry of health and
well informed.
other stakeholders should take advantage of
Comparisons among the participants showed this outlet since the patronage and its
that teachers were the group with the least level effectiveness is high.
of Awareness of BC. Interestingly, both
We found that professional nurses contributed
university students and market women were
most to teaching a majority of the participants
much more aware of BC than medical students.
how to perform BSE. Nursing roles have often
However, this difference was not significant,
extended beyond clinical activities, even
probably due to numbers. This is a surprising
though such extended roles are not official paid
outcome because, as medical students, many
duties in some circumstances. However, the
would argue that they are more exposed and

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impact of such sacrificial engagements cannot attributed to the fact that our research was
be overemphasized. Nurses have many contact carried out on a diverse population rather than
hours with clients than most other health solely on healthcare workers, contrary to these
service personnel; this proximity gives nurses studies.
an added advantage in building professional However, market women in this current study
relationships. Therefore, it would be prolific to had poor practice attitude (20%) compared to
encourage and support nurses to effectively nurses (59.2%), university students (46.6%),
engage in public health education/awareness and medical students (31.2%). This supports
campaigns as an add-on duty. previous studies' findings that highlighted the
In this study, teachers were the least aware of association between occupation, educational
BSE, yet they equally stand a higher chance of level, and BSE practice [22,31].
being the professionals who could educate most
We found that BSE's practice improved with
people about BSE's best practices due to their increasing age among the participants after 25
job description. This calls for action in years and declined after age 50. This finding
equipping such groups with the requisite skills supports the ongoing debates about the link
to champion awareness campaigns. Contrary to between age and BSE practice [32,33]. Many
this finding, Kumarasamy et al., in their study researchers have consistently listed higher
among rural women in India, reported an health motivation, higher perceived self-
association between Awareness of BSE and efficacy, and marital status as essential
educational levels [27]. predictors of BSE practice among women [34–
Regarding BSE practice, our findings revealed 37].
that only 37.2% practiced BSE regularly,
although many (87.6%) were aware of BSE. A
similar study conducted in Ghana reported a CONCLUSION
90.9% awareness rate, with only an 8.1% The knowledge of BC’s risk factors and BSE
practice rate among the participants [28]. This was remarkable but varied in the various
worrying trend has been widely reported occupational categories. However, only a few
[22,23,25,29,30]. The Awareness of BSE is participants reported they practiced BSE
essential and should translate into good regularly.
practice; this is the only way its benefits of
There is a need for widespread educational
aiding early detection in low resourced areas
campaigns to educate and encourage women on
would be noted. We were confident that high
the regularly practice of BSE. The inclusion of
awareness levels would correlate with the right
men in these crusades is long overdue.
practice attitude. This turn of events depicts a
Equipped with BSE's knowledge and skills,
need for an intensified educational campaign
men could assist and encourage their spouses to
with emphasis on good practice behaviors.
frequently examine themselves. Further
Contrary to our findings, a previous study research studies will be necessary to ascertain
conducted among healthcare professionals in men's role in championing BSE.
Nigeria reported that 95% of the study
participants practiced BSE at least once every
month [12,28] compared to 38.9% in this What is already known on this topic
current study. These disparities could be

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 The knowledge of breast cancer and the Med. 2018;54(4):315–317.

risk factors is abysmal among many 2. RamBihariLal Shrivastava S, Saurabh
African communities Shrivastava P, Ramasamy J. Self Breast
 The majority of women in Africa do not Examination: A Tool for Early
practice regular breast self-examination Diagnosis of Breast Cancer. Am J
Public Heal Res. 2013;1(6):135–139.
What this study adds
3. The Global Cancer Observatory G.
 This study adds to the current scientific Breast Cancer. Source: Globocan, 2018.
body of knowledge on the attitudes of World Heal Organ. 2018;876:2018–
African women regarding breast self- 2019.
examination 4. Adeloye D, Sowunmi OY, Jacobs W,
 The awareness of breast self- David RA, Adeosun AA, Amuta AO, et
examination is not a guarantee of good al. Estimating the incidence of breast
practice attitude cancer in Africa: a systematic review
 There is a need for intensive public and meta-analysis. J Glob Health.
education on breast cancer and the 2018;8(1). doi:10.7189/jogh.08.010419.
regular practice of breast self- 5. Brinton L, Figueroa J, Adjei E, Ansong
examination D, Biritwum R, Edusei L, et al. Factors
contributing to delays in diagnosis of
Competing interests
breast cancers in Ghana, West Africa.
The authors declare no competing interest. Breast Cancer Res Treat.
Authors' contributions 2017;162(1):105–114.
6. Hölzel D, Eckel R, Bauerfeind I, Baier
Conceptualization, ADBB, YT, and ST; Data
B, Beck T, Braun M, et al. Improved
curation, WJS, and HH; Formal analysis, WJS
systemic treatment for early breast
and H. H.; Investigation, ADBB, and HH;
cancer improves cure rates, modifies
Methodology, ADBB, YT, and ST; Project
metastatic pattern and shortens post-
administration, ADBB, YT, and ST;
metastatic survival: 35-year results from
Supervision, ADBB, YT, and ST; Writing –
the Munich Cancer Registry. J Cancer
original draft, ADBB, and WJS; Writing –
Res Clin Oncol. 2017;143(9):1701–
review & editing, ADBB, WJS, H. H., Y. T.
1712.
and ST
7. Elobaid Y, Aw TC, Lim JNW, Hamid
Acknowledgments S, Grivna M. Breast cancer presentation
We wish to thank the authorities of the various delays among Arab and national women
institutions that permitted us to conduct this in the UAE: A qualitative study. SSM -
study at their premises. Popul Heal. 2016;2:155–163.
8. Anjos KF dos, Boery RNS de O, Pereira
R, Pedreira LC, Vilela ABA, Santos
REFERENCES VC, et al. Association between social
support and quality of life of relative
1. Ewaid SH, Shanjar AM, Mahdi RH. caregivers of elderly dependents. Cien
Knowledge and practice of breast self- Saude Colet. 2015;20(5):1321–1330.
examination among sample of women 9. Allen TL, Van Groningen BJ, Barksdale
in Shatra/Dhi-Qar/Iraq. Alexandria J DJ, McCarthy R. The Breast Self-

INNOVATIVE JOURNAL I Jour Med Health Science 10 (10), 1332−1345 (2020) 1343
 BUUNAAIM ET AL.
INNOVATIVE JOURNAL

Examination Controversy: What nurses at the Federal Teaching Hospital

Providers and Patients Should Know. J Ido-Ekiti, Nigeria. J Public Health
Nurse Pract. 2010;6(6):444–451. Africa. 2016;7(1):11–14.
10. Black E, Richmond R. Improving early 17. Hassan EE, Seedhom AE, Mahfouz
detection of breast cancer in sub- EM. Awareness about Breast Cancer
Saharan Africa: Why mammography and Its Screening among Rural
may not be the way forward. Egyptian Women, Minia District: a
Globalization and Health. 2019;15(1):3. Population-Based Study. Asian Pacific J
11. ACS. American Cancer Society Cancer Prev. 2017;18:1623–1628.
Recommendations for the Early 18. Opoku SY, Benwell M, Yarney J.
Detection of Breast Cancer. 2017. Knowledge, attitudes, beliefs, behavior
https://www.cancer.org/cancer/breast- and breast cancer screening practices in
cancer/screening-tests-and-early- Ghana, West Africa. Pan Afr Med J.
detection/american-cancer-society- 2012;11:28.
recommendations-for-the-early- 19. Ranasinghe HM, Ranasinghe N,
detection-of-breast-cancer.html. Rodrigo C, Seneviratne RDA,
12. CCS. Canadian Cancer Society: Know Rajapakse S. Awareness of breast
your Breast. 2019. cancer among adolescent girls in
http://www.cancer.ca/en/prevention- Colombo, Sri Lanka: A school-based
and-screening/reduce-cancer-risk/find- study. BMC Public Health.
cancer-early/know-your-body/know- 2013;13(1):9–15.
your-breasts/?region=on. 20. Godfrey K, Agatha T, Nankumbi J.
13. Andegiorgish, Amanuel Kidane; Breast cancer knowledge and breast
Kidane, Eyob Azeria; Gebrezgi MT. self-examination practices among
Knowledge, attitude, and practice of female university students in Kampala,
breast cancer among nurses in hospitals Uganda: A descriptive study. Oman
in Asmara, Eritrea. BMC Nurs. Med J. 2016;31(2):129–134.
2018;17(33). 21. Sielska J, Matecka M, Dabrowska E,
14. Akhtari-Zavare M, Juni MH, Ismail IZ, Jakubek E, Urbaniak M. What do
Said SM, Latiff LA. Barriers to breast women know about breast cancer
self-examination practice among prophylaxis and a healthy style of life?
Malaysian female students: a cross- Reports Pract Oncol Radiother.
sectional study. Springerplus. 2015;20(5):321–327.
2015;4(1):1–6. 22. Al-Dubai SAR, Ganasegeran K, Alabsi
15. Ibrahim NA, Odusanya OO. Knowledge AM, Abdul Manaf MR, Ijaz S, Kassim
of risk factors, beliefs, and practices of S. Exploration of barriers to breast-self
female healthcare professionals towards examination among urban women in
breast cancer in a tertiary institution in Shah Alam, Malaysia: a cross-sectional
Lagos, Nigeria. BMC Cancer. study. Asian Pac J Cancer Prev.
2009;9:1–8. 2012;13(4):1627–32.
16. Gabriel OE, Ajetunmobi OA, Shabi 23. Baloushah S, Salisu WJ, Elsous A,
OM, Elegbede OT, Okere RA, Busari Muhammad Ibrahim M, Jouda F,
OA, et al. Awareness and practice of Elmodallal H, et al. Practice and
self-breast examination among female Barriers toward Breast Self-

INNOVATIVE JOURNAL I Jour Med Health Science 10 (10), 1332−1345 (2020) 1344
KNOWLEDGE OF BREAST CANCER RISK FACTORS AND PRACTICES OF BREAST
SELF-EXAMINATION AMONG WOMEN IN NORTHERN GHANA

Examination among Palestinian Women MK. Practicing breast self-examination

in Gaza City, Palestine. 2020:1–72020. among women attending primary health
24. Birhane K, Alemayehu M, Anawte B, care in Kuwait. Alexandria J Med.
Gebremariyam G, Daniel R, Addis S, et 2013;49(3):281–286.
al. Practices of Breast Self-Examination 31. Madubogwu C, Egwuonwu A,
and Associated Factors among Female Madubogwu N, Njelita I. Breast cancer
Debre Berhan University Students. Int J screening practices amongst female
Breast Cancer. 2017;2017:1–6. tertiary health worker in Nnewi. J
25. Aluko JO, Ojelade MF, Sowunmi CO, Cancer Res Ther. 2017;13(2):268.
Oluwatosin OA. Awareness, 32. Jarvandi S, Montazeri A, Harirchi I,
knowledge, and practices of breast Kazemnejad A. Beliefs and behaviors
cancer screening measures among of Iranian teachers toward early
female postgraduate students of a detection of breast cancer and breast
Nigerian Federal University: a cross- self-examination. Public Health.
sectional study. Afr J Med Med Sci. 2002;116(4):245–249.
2014;43(Suppl 1):79–86. 33. Noroozi A, Jomand T, Tahmasebi R.
26. Bulut A, Bulut A. Knowledge, attitudes, Determinants of breast self-examination
and behaviors of primary health care performance among Iranian women: An
nurses and midwives in breast cancer application of the health belief model. J
early diagnosis applications. Breast Cancer Educ. 2011;26(2):365–374.
Cancer Targets Ther. 2017;9:163–169. 34. Didarloo A, Nabilou B, Khalkhali, HR.
27. Kumarasamy H, Veerakumar A, Psychosocial predictors of breast self-
Subhathra S, Suga Y, Murugaraj R. examination behavior among female
Determinants of Awareness and students: An application of the health
practice of breast self-examination belief model using logistic regression.
among rural women in Trichy, Tamil BMC Public Health. 2017;17(1):1–8.
Nadu. J Midlife Health. 2017;8(2):84– 35. Avci IA. Factors associated with breast
88. self-examination practices and beliefs in
28. Fondjo LA, Owusu-Afriyie O, Sakyi female workers at a Muslim
SA, Wiafe AA, Amankwaa B, community. Eur J Oncol Nurs.
Acheampong E, et al. Comparative 2008;12(2):127–133.
Assessment of Knowledge, Attitudes, 36. Abolfotouh MA, Banimustafa AA,
and Practice of Breast Self-Examination Mahfouz AA, Al-Assiri MH, Al-Juhani
among Female Secondary and Tertiary AF, Alaskar AS. Using the health belief
School Students in Ghana. Int J Breast model to predict breast self-examination
Cancer. 2018;2018:1–10. among Saudi women Health behavior,
29. Al-Sharbatti SS, Shaikh RB, Mathew E, health promotion, and society. BMC
Al-Biate MAS. Breast Self Examination Public Health. 2015;15(1):1–12.
Practice and Breast Cancer Risk 37. Hajian-Tilaki K, Auladi S. Health belief
Perception among Female University model and practice of breast self-
Students in Ajman. Asian Pacific J examination and breast cancer
Cancer Prev. 2013;14(8):4919–4923. screening in Iranian women. Breast
30. Alazmi SF, Alkhabbaz A, Almutawa Cancer. 2014;21(4):429–434.
HA, Ismaiel AE, Makboul G, El-Shazly

INNOVATIVE JOURNAL I Jour Med Health Science 10 (10), 1332−1345 (2020) 1345