Pa ge 1 Pa ge 21 American Journal of Medical Science and Innovation (AJMSI) Assessment of Breast Cancer Awareness Among Women of Reproductive Age in Akure South Local Government Area of Ondo State Omotayo Lydia Mojisola1* Volume 2 Issue 1, Year 2023 https://journals.e-palli.com/home/index.php/ajmsi Article Information ABSTRACT Received: February 02, 2023 Accepted: March 02, 2023 Published: March 06, 2023 Incidence of breast cancer is increasing worldwide. Breast cancer is the most commonly diagnosed cancer as a major cause of cancer death among woman according to national breast cancer foundation in 2016. The current prevalence of breast cancer in Nigeria is 12.5% which implies 1 out of 15 women are living with the disease. This worrisome development will continue to attract attentions and actions of governmentsat all levels, NGOs, health institutions and researchers. The study aims to assess breast cancer among women of reproductive age in Akure South Local Government Area of Ondo State. The sample size of 110 women of child-bearing age were selected randomly across Akure south, eleven political wards through multistage sampling technique. The data generated from in-depth interviews of the informants and from secondary sources like government journals, medical publications, hospital records, NGOs Articles and internet materials were qualitatively analyzed. The study revealed that majority of the respondents did not have adequate breast cancer awareness. The study concluded that the government and critical stakeholders should adopt more proactive approaches towards effective advocacy programmes that can checkmate the high mortality rate of the disease as the existing information channels have not impacted significantly on breast cancer awareness campaigns. Therefore, it is hereby recommended that governments at all levels in collaboration with NGOs, health organizations, religious bodies, mass media, traditional institutions and other stakeholders should intensify well coordinated efforts to create the needed awareness about the scourge among the womenfolk who incidentally have the highest prevalence of the disease. Keywords Awareness, Breast Cancer, Mortality, Prevalence, Screening 1 Department of Public Health University of Cambodia, Cambodia * Corresponding author’s e-mail: omotayolydiamojisola@gmail.com INTRODUCTION Breast cancer is the most common cancer affecting 25.2% of women and is also the second leading cause of cancer-related deaths among women according to (Okunnuga.N et al. 2021). Almost half of breastcancer cases and 60% of breast cancer-related deaths are estimated to occur in middle-and –low-income countries. Globally, the devastating effects on women diagnosed with breast cancer are appalling. Global cancer statistics shows increased global cases of breast cancer and the rise is occurring at a faster rate in population of the middle-and-low-income countries which may be due to increase in population growth and aging. Breast cancer is an aggressive disease affecting women, irrespective of their age category. Women are particularly vulnerable and susceptible to breast cancer and their risks increase with advanced age. The origin of breast cancer has not been fully unraveled but is attributable to some inter- related factors of genetics, hormones, theenvironment, socio-biology and physiological factors according to American Cancer Society (2013). In the report by Lydia and Mpunga (2015), it was indicated that deaths as aresult of breast cancer in Nigeria reached 13,264 or 0.70% and the age adjusted deathrate is 28.11 per 100,000 population, ranking Nigeria 4th in the world. Adebamowo and Ajayi (2021) also stated that the malignant cells are developing in the tissue. Breast cancer is the most common cancer in Nigeria. In 2005, breast cancer was found to be the most common in Nigeria. In the North-West geographical zone of Nigeria, cancer ofthe breast is second to Cervix, while the Cancer registry at the University College Hospital (UCH) Ibadan revealed that it is the leading malignancy among women. Also, in the north-Central, breast cancer constitutes 22.41% of the new cancer cases registered in 5 years and accounts for 35.41% of all cancers in women. Breast cancer isundoubtedly the most dreaded cancer with lots of psychological impacts and one of themost popular malignancies that affect about one in every nine women. It is a disease inwhich the malignant cells are developing in the tissue of the breast. Breast cancer is of two types, Lobular cancer which begins in many small sacks in the breast that producemilk and ductal cancer which develops in the tubes that carry milk from the lobules tothe nipple. It is also the type of cancer having the highest prevalence (45.7%) among the female in Nigeria and border countries. Common signs and symptoms of breast cancer include a change in the way the breast or nipple feels, change in how the breast or nipple seems and discharge of the nipple. It is interesting to know that as debilitating as breast cancer disease is, majority of Nigerian women have little or no knowledge of the disease and even in situations where they are aware of the disease, their attitude towards seeking healthcare is negative causing their untimely or preventable death https://journals.e-palli.com/home/index.php/ajmsi Pa ge 22 https://journals.e-palli.com/home/index.php/ajmsi Am. J. Med. Sci. Innov. 2(1) 21-25, 2023 (Tayo, G. et al. 2019). It has been observed that certain socio-cultural, religious, genetic and economic factors are responsible for this negative attitude. Statement of Problem Breast cancer is currently the most common type of cancer worldwide with 2.26 million cases recorded in 2020 (WHO 2020). It is also the most common cancer among women both in developed and developing countries and a major cause of public health concern. While it exists around the globe, developed countries have ahigher incidence rate and the incidence rate also varies by ethnicity and race (Obalase and Adegboro 2017). Breast cancer was also the 5th leading cause of deaths worldwide in 2020 with 685,000 death attributed to it (WHO, 2021). In Nigeria breast cancer caseswere historically low but are now increasing as a result of urbanization and lifestyle changes. It is the leading cause of cancer death currently representing about 23% of allcancer cases and approximately 18% of deaths are attributed to it. In Nigerian women, breast cancer seems to be diagnosed at an advanced stage and the chance of survival are low (Adebamowo and Ajayi 2007). Women in the country area also more frequently diagnosed with triple-negative breast cancer than women of European ancestry (Mccormack, Adebamowo and Dos-Santos-Silva 2016). Following late presentation of the disease the only option available are expensive treatment procedure which maybe unaffordable. The prevalence of breast cancer among women in Ondo state, south western partof Nigeria is on the high side from the clinical records of confirmed breast cancer patients, between March 2013 and April 2019 attending the oncology outpatient clinic at University of Medical Sciences Teaching Hospital, Akure, Ondo State, Nigeria, reproductive women younger than 40 years constitutes 37.5% of the sample population of 20-89 years while those older accounted for 63.5% General Objective of the study This is to assess breast cancer awareness among women of reproductive age in Akure South Local Government Area of Ondo State. Specific Objectives of the study 1. To assess the most used channel(s) for breast cancer awareness. 2. To evaluate the influence of culture on breast cancer awareness. 3. To determine how often do women of reproductive age in Akure South Local Government conduct self breast examination. 4. To determine the level of breast cancer awareness among women of reproductive age in Akure South Local Government ResearchQuestions 1. What is the most used channel(s) of information for breast cancer awareness? 2. Does culture have influence on breast cancer awareness? 3. How often do women of reproductive age in Akure South Local Government conduct self breast examination? 4. What is the level of breast cancer awareness among women of reproductive age in Akure South Local Government? Significance Apart from adding to the body of knowledge about breast cancer disease, this study will be useful to the government, policy makers,health institutions, health care providers and research centers to improve on their breast cancer awareness strategies in order to checkmate the high mortality of the disease among women. LITERATURE REVIEW According to American cancer society, there are several types of breast cancer. The commonest type is ductal carcinomas. This begins in a milk duct. Another type is lobular carcinoma. This begins in a lobule, one of the tiny glands that produce milk. ‘Invasive’ breast cancer involves cancerous cells spreading to nearby tissues and other parts of the body while non- invasive’ breast cancer remains in place of origin. The cells may eventually became invasive. Breast cancer occurs where there is a genetic mutation or damage to DNA. This can be associated with exposure to estrogen, inherited genetic defects or inherited genes that can cause cancer such as BRCA1 and BRCA2 genes It has been argued that a lack of basic knowledge and quality information delivery system for breast cancer is a great impediment to the life and well-being of women. Tayo, Tolulope, Emmanuel and Olabode (2019) Opined that breast cancer has been a major cause of death subtly killing women-especially thosewith little or no education. This is compounded by lack of timely information aboutbreast cancer and poor diagnostics screening methods for early detection. As importantas knowledge of breast cancer is, it is not sufficient unless socio- cultural factor are taken into consideration by the health professionals providing direct healthcare. Insufficient information concerning breast cancer has also been observed among rural and urban dwellers in Nigeria; it is responsible for the poor perception of the ability tocure cancer earlier detected and the efficacy of screening tests. Furthermore, the lack ofawareness on the issue of vulnerability and susceptibility associated with breast cancerdiscouragemany women from seeking intervention early or associate the symptoms they are experiencing with other health conditions. Level of awareness regarding how to perform simple life saving diagnostic breastcancer checks such as self breast examination (SBE) further compounds the problem of late detection. Empowerment of women with information on BSE is paramount importance, https://journals.e-palli.com/home/index.php/ajmsi Pa ge 23 https://journals.e-palli.com/home/index.php/ajmsi Am. J. Med. Sci. Innov. 2(1) 21-25, 2023 especially in countries without modern technologies for breast cancersscreening. Most of the Nigerian rural communities lacked the required technologicalresources, but SBE can contribute greatly if women are informed about the technique,and regular practice would reduce late presentation. According to American Cancer Society, Breast Self Examination (BSE) is a screening method that is being used to defect early breast cancer. This involves a woman examining her own breasts to feel the breasts for possible lumps, swelling or distortion. Mammography screening may also be done to detect breast cancer in asymptomatic women. In spite of its limitation in LMCs due to challenge of poor infrastructure, poverty, and inadequate human resources, it has been seen as the method of choice for screening and diagnosis which can significantly reduce breast cancer morbidity and mortality. Certain socio-cultural factors also contribute to breast cancer prevalence in Nigeria. As opined by Akhigbe and Akhigbe (2012), health beliefs vary across culture, and the fatalistic consequence ofcancer may discourage many from participating in health –promoting behaviors. This isbecause illnesses or catastrophic eventsinthispart of the worldare attributedto ahigher power (such as God), or they are meant to happen and cannot be avoided; as aresult, fatalism become part of the person’s world view. Chronic conditions in many African societies are often associated with witchcraft and evil spirits. Cultural values and ethnic diversity have an impact on health beliefs, which may influence how rural women interact with the western medication, especially conditions such as breast cancer. According to Molute and Molute (2015). Some women delay seeking treatment because of fear or stigma concerning their daughters as it is believed that they also might be affected by breastcancer and might not be considered for a good marriage. Furthermore, it is believed thatcancer is a death sentence from God. All these have continued to be crucial factors thatmay account for breast cancer prevalence in Nigeria and other sub-Sahara Africancountries. This study seeks to ascertain the level of breast cancer awareness among women of reproductive age in Akure South local government area of Ondo State. Theoretical Framework This study is anchored on health belief theory. According to (Rosenstock & Becker, 1994), health belief theory is a social psychological health behavior change modeldeveloped to help explain and predict health related behavior with respect to acceptanceof health intervention. This implies that individual’ beliefs about health conditions will go a long way in predicting their health related behavior towards the health condition. Therefore, the relevance of this theory to this work rests on the fact that women ofreproductive age acceptance of breast cancer interventions well largely depend on their perceived causes of breast cancer and the hope of getting the needed treatment from any available interventions. METHODOLOGY This involves qualitative research by reviewing literature, medical publications, hospital records, government journals, NGO’s articles and internet materials. They are also corroborated by face to face interviews purposively conducted in eleven (11) political wards in Akure South Local Government area among 110 women of reproductive age. The eleven political wards are: Aponmu, Gbogi / Isinkan 1, Gbogi / Isinkan 2, Ijomu /Obanla, Ilisa, Oda, Odopetu, Oke-Aro, Uro,Isolo/ Oshodi, Owode/imuagan. The sample size of 110 informants were allocated appropriately among communities selected through multi- stage sampling techniques within these eleven political wards. The data elicited from both primary and secondary sources were analyzed and presented as this research report. Socio- demographic profile of the informants revealed that the informants are with in the child-bearing age bracket of 15–49 years. Majority of the maregraduates and married. They are also working and their consents were sought and obtained before the interview. Research Question 1 What is the most used channel of information about breastcancer awareness among women of reproductive age in Akure south localgovernmentarea? From the analysis of the opinions of 110 respondents, 44(40%) respondents chose hospital as the most used channel of information aboutbreast cancer among women reproductive age in Akure south local government.: 31(28.2%) respondents chose mass media which consists of television. Radio, Newspapersand the internet : 23(20.2%) respondents chose friends through group discussions andsharing of information while : 12(10.9%) respondent chose market places. This showsthat hospital is the most used channel where information about breast cancer disease isdisseminated to create the needed information among women of reproductive age in Akure South Local Government Area. Research Question 2 Does culture have influence on breast cancer awareness among women of reproductiveagein Akure south? From the analysis of the opinions of 110 respondents : 67(60%) agreed that culture hasinfluence on the breast cancer awareness: 30(27%) is agreed while: 13(11.8%) were undivided. This shows that culture has influence on breast cancer awareness among women of reproductive agein Akuresouth localgovernment area. Research Question 3 How often do reproductive women in Akure South Local Government conduct self-breast examination and breast screen examination? From the analysis of the opinions of 110 respondents: https://journals.e-palli.com/home/index.php/ajmsi Pa ge 24 https://journals.e-palli.com/home/index.php/ajmsi Am. J. Med. Sci. Innov. 2(1) 21-25, 2023 72(66.5%) respondents conducted self breast examination once in a while. 17(15.5%) respondents conducted self- breastexamination monthly while 21(19%) respondent conducted self-breast examination regularly. This results show that women of child bearing age in Akure South Local Government Area had poor attitude towards the practice of breast cancer screening. Research Question 4 What is the level of awareness of breast cancer among woman of reproductive age in Akure South Local Government Area? Symptoms of breast cancer From the analysis of opinions of 110 respondents: 78(71%) respondents did not have adequate information about symptoms of breast cancer disease while 32 (29%) respondents had. Risk factors of breast cancer From the analysis of opinions of 110 respondents 83(75%) respondents did not have adequate information about the risks factor of breast cancer disease while 27(24.5%) respondents had. Causes of breast cancer From the analysis of opinions of 110 respondents, 87(79%) respondents did not have adequate information while 23 (21%) respondentshad. Treatment of breast cancer From the analysis of opinion 110 respondents: 92(84%) respondents did not have adequate information while 18(16%) respondents had. From the results, it shows that women of reproductive age in Akure south did not have adequate awareness about breast cancer. RESULTS AND DISCUSSION The purpose of this study is to assess breast cancer awareness among women of reproductive age in Akure south local government Area of Ondo state. The study revealed that majority of child bearing women had inadequate awareness about breast cancer which was a result of in effective communication channels and programmes by the government and stakeholders and strong influence of cultural belief of the inhabitants on illnesses and catastrophic events. It also revealed that majority of these women did not carry out self-breast examination which could have aided early detection of the disease and reduced eventual fatality. However, the findings of the study provided more insight into the understanding of the breast cancer, this encompasses the causes and prevention of breast cancer, the risk factors and types of breast cancer and symptoms and treatment of breast cancer and the recommendations that will increase the present tempo of the disease awareness among women of reproductive age in Akure south local government area. CONCLUSSION Breast Cancer is a fatal disease that has affected significant number of child bearing women in Akure South Local Government Area. It could be concluded that inter-related factors such as age, education, family history , culture, individual attitude, and socio – economic factors have influence on the disposition of this women towards the awareness of the diseases and its control. Also, the study concluded that the existing efforts of the government and stakeholders cannot stem the rising tide of breast cancer incidence. Hence, there should be more collaborative efforts of the stakeholders and more vigorous awareness campaigns in Akure South Local Government Area.It is concluded that poor breast cancer awareness and poor attitude to breast self examination (BSE) practices are predominant among women of reproductive age in Akure South Local Government Area and are responsible for the high prevalence and presentation of the disease that had caused premature but preventable deaths of many notable personalities within the community. The finding of this study are similar to previous studies conducted by (Okunnuga, N. et al. 2021) on Prevalence, Stage and Sociodemographic Pattern of Breast Cancer in a Tertiary Institutions, South West, Nigeria, Obalase, S.B., and Adegboro, J.S. (2017) on Breast cancer screaming practices among women in Akure south Local government Area of Ondo State (Olowokere, A.E. et al. 2012) on breast cancer knowledge and screaming practices among selected rural communities of Nigeria and (Omotara, B. et al. 2012) on awareness, attitude and practice of rural women regarding breast cancer in Northeast Nigeria. The future research should dwell on the interpretation of religious beliefs of women on their level of awareness about breast cancer disease. The following measures are, therefore, recommended after juxtaposing this study with the positions of previous scholars.. RECOMMENDATIONS 1. There should be greater involvement of mass media in breast cancer awareness campaigns by the governments at all levels. 2. Breast cancer screening should be made accessible to women at little or no cost. 3. 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