Breast Self-Examination (BSE): Association between “Belief in BSE” and “Awareness of BSE” among University Female Students in Uganda ()
1. Introduction
The leading cause of amongst women throughout the world is Breast Cancer (Hortobagyi GN, et al., 2005) [1]. The increase in mortality is mainly due to late diagnosis of the disease, which is a consequence of a lack of knowledge and awareness regarding breast cancer, primarily in women in developing countries. Early detection of breast cancer increases the treatment’s effectiveness, resulting in a better prognosis, and reducing morbidity and mortality rates (Elmore, et al., 2005) [2].
A Breast Self-Examination (BSE) is a technique which allows an individual to examine his/her breast tissue for any physical or visual changes. It is often used as an early detection method for breast cancer. Although most BSEs are carried out by women, self-breast examinations should be carried out by both men and women at least once each month beginning at age 18. The core purpose of Breast Self-examinations is to detect early breast cancer during screening (Gupta, S.K, etal. 2009) [3]. Breast Cancer Screening (BCS) are test performed to find disease before symptoms begin, thereby increasing its chances for treatment, cure and other prognostic outcomes.
In Africa, breast cancer is responsible for 28% of all cancers and 20% of all cancer deaths in women. (Fidler, 2012) [4]. Incidence rates are still generally low in Africa and estimated to be below 35 per 100,000 women in most countries (compared to over 90 - 120 per 100,000 in Europe or North America). A study on breast cancer in low-income states revealed that the incidence rates based on age (per 100,000 women) scored 20.2 in eastern Africa, 13.5 in middle Africa, 24.8 in western Africa, and 31.8 in southern Africa (Sandelin K, et al. 2002) [5].
In a cohort study on the breast cancer survival experiences at a tertiary hospital in sub-Saharan Africa, it was suggested that the main problem with cancer treatment in Uganda is that patients come to the hospital when the cancers have already developed to advanced stages (Galukande, Wabinga, et al. 2015) [6]. The researchers of this study urged the government of Uganda to invest in sensitizing the public and extending cancer screening services for early detection. Furthermore, according to a study on Knowledge and Awareness of Breast Cancer and Screening Methods among Female Undergraduate Students in a Semi-Urban College of Culture and Humanities, Nigeria (Olufemi, et al. 2017) [7], 62% of the respondents had good knowledge about breast cancer, 68.2% were aware that a breast self-examination is a form of screening methods and sixty-seven percent, 67.3% were aware that mammogram is effective in detecting lumps early while 68.8% of the respondents were not aware that clinical breast examination is a screening method for breast cancer. A significant association was observed between the perceived level of threat from cancer and screening practice and the perceived benefit from breast cancer screening methods and screening practice.
Additionally, a study showing Breast self-examination awareness and practices in young women in developing countries revealed the overall response rate was 90.9%. Although 71.4% of the women knew what BSE was, only 33.1% had performed it. The majority of the participants considered that BSE is important in the early detection of breast cancer. With 59.7% of the population having adequate knowledge, 87.2% had a positive attitude toward BSE. A medical background was found to be a significant predictor of adequate knowledge and a positive attitude toward BSE (Ahmed, et al. 2018) [8].
Last but not least, a study that was performed on female university students relating to the associated factors with the practices of BSE in Ethiopia; revealed that 64% of the participants had heard about BSE and 30.25% had good knowledge about BSE and about 28.3% had performed BSE (Birhane, et al., 2017) [9]. Inadequate knowledge of the BSE techniques was cited as the main reason for not practising BSE. Ultimately, being well-conversant on the BSE technique was important and useful in identifying early signs of breast cancer deemed statistically significant with the practice of BSE (Birhane, et al., 2017) [9].
2. Methodology
2.1. Study Design
The study design utilized a cross-sectional study design and employed a quantitative method of data collection.
2.2. Study Setting and Location
The data collection was conducted from different Universities in Kampala Uganda.
2.3. Study Population
The study population was Female University students aged 19 - 30 years in Kampala, Uganda.
2.4. Sample Size
The sample size was determined by the population of University students in Kampala, Uganda in 2019 as drawn from the Uganda Bureau of Statistics, 2014. This population was computed into Fisher’s formula.
It was determined by using fisher’s formula;
whereby n = the preferred sample size (if the target population is greater than 10,000)
Z = the standard normal deviate 1.96 at a 95% confidence interval
P = estimated prevalence of breast cancer in the population,
P = prevalence (23.4) 23.4/100 =0.234
e = level of statistical significance set at 0.05.
e = design effect = 1 and
e = standard error. 1.5% = 0.05/100 = 0.05
n = (1.96)2
Therefore;
Since the target population is less than 10,000, the final sample estimate (nf), we calculated using the formula:
The minimum sample size is 260
2.5. Sampling Strategies and Procedures
This research study employed a descriptive cross-sectional study design with a quantitative method of data collection, using the cluster and the simple random sampling method.
2.6. Inclusion Criteria
All University female students of the selected universities were within the age bracket of 19 - 30 years of age.
2.7. Exclusion Criteria
Female University students below the age of 19 years of age or above 30 years of age, and who were away at the time of carrying out the research were omitted from the study. Finally, female students within the age bracket of 19 - 30 years of age who refused to consent to the study were excluded from the study.
2.8. Data Collection Methods
Using only quantitative methodology, a structured questionnaire was used to obtain data from the individuals.
2.9. Measurement of Variables
2.9.1. Independent Variables
Benefits of Self-Breast Examination (BSE): Examples of benefits include; Early detection of cancer and prevention of cancer.
2.9.2. Dependent Variable
The dependent variable in this study was the Awareness of Breast Self-Examination.
2.10. Data Analysis
The data was analyzed using SPSS version 20 and the univariate and bivariate analyses were done to construct categories or themes by continuous comparison of bits of data with each other.
2.11. Validity of Instruments of Data Collection
The researcher ensured the content validity of the questionnaire by constructing questions that conformed to the study conceptual framework and also carrying out a pre-testing survey to ascertain preciseness, conciseness, and comprehension of the Questionnaire.
2.12. Ethical Considerations
Approval Letters
Before embarking on the study, the research team sought approval from the Victoria University Uganda research and ethical committee letter to carry out the study. The approval was granted as evidenced by an Approval letter. Guidelines were adopted and emphasized in the questionnaire i.e. the purpose of the study was explained to participants utilizing an information sheet. The participants were assured of strict confidentiality of any information they provided. The research team also sought permission from the Department of Public Health at KCCA and was granted permission to conduct the study from different locations of University hostels in Kampala.
Informed consent
Also, the following guidelines were adopted and emphasized in the questionnaire; the purpose of the study was explained to participants utilizing an information sheet. The participants were assured of strict confidentiality of any information they should provide. The participants were treated with dignity and respect. Confidentiality and anonymity were assured to the participant by using codes for identification instead of their names. Only those who consented took part in this study.
Privacy and confidentiality
All participants took part in this study voluntarily. No form of manipulation was applied to the respondents to partake in this study.
2.13. Limitation of the Study
Language barrier: This limitation was overcome with the support of a translator. He translated English into the local/native language for non-English speaking participants to understand.
3. Results
Out of 260 questionnaires distributed, 259 valid responses were retrieved and thus the study had a 100% response rate.
Uni-Variate Analysis
From Table 1, it was found that the majority (166) of the University students were aware of the Breast Self-Examination technique.
Table 2 above indicates the respondents’ awareness of the benefits of BSE. This study found that the majority (192) of the respondents believed that BSE helps in the prevention of breast cancer. Amongst the 259 respondents to the question do you think BSE helps in the early detection of breast cancer—the majority (217) of the University students said Yes.
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Table 1. Respondents’ knowledge of breast self-examination (BSE) technique.
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Table 2. Respondents’ awareness of the benefits of breast self-examination (BSE).
From the figure above, 74.1% of the respondents stated that BSE aids in the prevention of cancer and 83.8% stated that BSE also aids in the early detection of breast cancer (Figure 1).
Bivariate Analysis
Table 3 reveals a significant association between the Benefits of Breast Self-Examination and awareness; amongst University students who believed that BSE helps in the prevention of breast cancer, the majority (70.3%) of them was more likely to be aware of Breast Self-examination compared to students who did not think that BSE helps in the prevention of breast cancer. Amongst those who did not think the latter, the majority of them (53.7%) were more likely not to be aware of Breast Self-Examination. Thus, there was a statistically significant association between the Benefit of the prevention of breast cancer and the awareness of BSE (X2 =12.476; P-Value = 0.000).
Additionally, among the University students who responded Yes to the question Do you think BSE helps in the early detection of breast cancer? This study revealed that the majority (71%) were more likely to be aware of BSE. Consequently, it was found that the majority (71.4%) who did not think BSE helps in the early detection of breast cancer were more likely not to be aware of Breast Self-Examination, deeming the association between Benefits of BSE and awareness of BSE statistically significant (X2 = 27.484; P-Value = 0.000).
4. Discussion
This study found that the majority of the sampled female University students who believed that BSE can aid in the prevention (70%) and early detection of breast cancer (71%) were more likely to be aware of this technique as compared to those who did not believe it; this association was statistically significant, X2 = 12.476; 27.484 and a P-Value of 0.000; 0.000, respectively.
These research findings agree with Birhane’s study which assessed the practice and associated factors of breast self-examination (BSE) among female University students in Ethiopia. In Birhane et al.’s study, 64% of the participants reported having heard about BSE, 30.25% had good knowledge about BSE, and 28.3% had
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Table 3. Associations between benefits of BSE and BSE awareness.
* = significant value.
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Figure 1. Bar chart showing the percentage distribution of awareness of the benefits of breast self-examination.
performed BSE. All three variables i.e., Lack of knowledge on how to perform BSE, and having a perception that BSE were all significant predictors of practices of BSE (Birhane, 2017) [10].
Additionally, more similar studies have shown amongst women have revealed associations between positive opinions and theories about the benefits of BSE and awareness of BSE practice. An example is a study on Factors associated with breast cancer screening behaviours in Turkey. It revealed that Higher susceptibility to having heard/read about breast cancer and BSE was significantly associated with performing BSE (Secginli S, 2006) [11].
By contrast, a study by Petro-Nustus and Mikhail (2002) [12] investigated factors and beliefs that may be related to the practice of breast self-examination (BSE) undergraduate among a group of Jordanian women. The results of this study showed that even though 67% of the population knew Breast Self-Examination, only 25% of that selected population were actively engaged in regular Breast self-examination, hence this deemed no statistical significance (Petro-Nustus & Mikhail, 2002) [12].
5. Conclusion
From this study, research findings indicate statistically significant associations between the Benefits of Breast Self-Examination (prevention and early detection of breast cancer) and awareness of BSE; in that, the University students who believed in the benefits of BSE were more likely to be aware of BSE as compared to those who did not.
Recommendation
Despite an association between the benefits of BSE and its awareness, it is highly recommended that more emphasis should be placed on health education and health promotion activities for women of younger ages to increase the knowledge of the practice of BSE since studies have shown a higher mortality rate of this specific population. Additionally, women of reproductive age should be sensitized to the importance of good nutritional practices in the prevention of non-communicable diseases such as breast cancer.
Declarations Section
Ethics Approval and Consent to Participate
Before embarking on the study, the research team sought approval from the Victoria University Uganda research and ethical committee letter to carry out the study. The approval was granted as evidenced by an Approval letter. Guidelines were adopted and emphasized in the questionnaire i.e. the purpose of the study was explained to participants utilizing an information sheet. The participants were assured of strict confidentiality of any information they provided. The research team also sought permission from the Department of Public Health at KCCA and was granted permission to conduct the study from different locations of University hostels in Kampala.
Conflicts of Interest
The authors declare NO CONFLICT OF INTEREST and attest to the fact that this paper has never been published in any journal or book.
Funding
This research was self-funded by all the authors.
Authors’ Contributions
All four (4) authors had equal contributions; starting from the concept, data collection, analysis, writing and typesetting of this article.
Acknowledgements
The authors wish to acknowledge the following persons/organizations:
1) Kampala Capital City Authority.
2) Victoria University, Kampala Uganda.
3) Selected Universities in Kampala Uganda that participated in this research study.
4) University Hostels and their patrons and matrons.
5) All University female students participated in the research study.
Abbreviations
1) BSE-Breast Self-Examination
2) SPSS-Statistical Package for Social Sciences
3) BCS-Breast Cancer Screening
4) KCCA-Kampala Capital City Authority
5) SSA-Sub-Saharan African