EXAMINATION OF BREAST CANCER SCREENING BEHAVIOUR AMONG FEMALE SECONDARY SCHOOL TEACHERS IN RIVERS STATE

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Yenagoa Medical Journal
Vol. 4 No. 3, July – September 2022
67 | P a g e
EXAMINATION OF BREAST CANCER SCREENING BEHAVIOUR AMONG
FEMALE SECONDARY SCHOOL TEACHERS IN RIVERS STATE
Inyang ME1*, Madume AK2, Kua PL3
1Department of Human Kinetics, Health and Safety Studies, Ignatius Ajuru University of Education, Rumuolumeni,
Port Harcourt, Nigeria.
2Department of Physiotherapy, Rivers State University Teaching Hospital, Port Harcourt, Nigeria.
3Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port Harcourt, Nigeria.
*Correspondence: Inyang, Mayen Etim; +234 818 536 3146; inyangmayenetim@yahoo.com
INTRODUCTION
The breast is a mammary gland, it lies within the pectoral
region. Breast cancer is a disease that affects the breast
and it occurs due to the over proliferation of breast cells.
Screening is the examination of individuals without
symptoms of any form, in order to detect disease or find
out if they are at increased risk of a specific disease. It is
often the first step in making a definitive diagnosis. The
purpose of breast cancer screening is to find women who
have breast cancer before the appearance of any symptom,
in order to offer treatment early. It aims at detecting the
disease at an early stage to improve treatment outcome.1,2
The screening practice of individuals is very important for
the effective control of breast cancer. Early detection of
breast cancer which is key to positive treatment outcome
can be achieved through good screening practice. Early
detection of breast cancer through regular screening
activities such as mammography/breast self-examination
(BSE), clinical breast examination (CBE) and magnetic
resonance imaging (MRI) have been found to decrease
mortality rates by 25-30%.3
Screening mammography is a low dose X-ray
examination modality with high resolution that reveals
changes in the breast that may be cancerous.4,5 Breast self-
examination as a breast cancer screening method is a
process whereby women examine their breast regularly to
detect any abnormal lumps or swelling in order to seek
prompt medical attention. It is a noninvasive adjuvant
screening method for detection of early breast cancer.
Cite this article Inyang ME, Madume AK, Kua PL. Examination of Breast Cancer Screening Behaviour Among Female
Secondary School Teachers in Rivers State. Yen Med J. 2022;4(3):67–73.
Original Article
Abstract
Background: Female secondary school teachers play a very important role in creating basic awareness about breast cancer
screening among their students.
Objective: To examine breast cancer screening behaviour among female secondary school teachers in Rivers State.
Materials and Methods: This was a descriptive survey conducted among female secondary school teachers in Rivers State. A
multistage sampling technique was used to select 720 participants from ten LGAs in the two areas (upland and riverine area)
of the State. A validated semi-structured questionnaire with a reliability coefficient of 0.85 for screening practice was used to
collect data. Data collected were analysed using IBM SPSS Statistics version 21 and presented in tables and percentages.
Result: About 60% of female secondary school teachers in Rivers State had a low extent of breast cancer screening practice.
Conclusion: Female secondary school teachers in Rivers State have a poor breast cancer screening behaviour.
Keywords: Breast cancer, Female teachers, Screening and screening behaviour.

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When mammography screening facilities are not
available in the rural and poor urban areas, breast self-
examination becomes a useful measure for the detection
of breast cancer. Though the procedure of breast self-
examination is simple, and requiring little time, it can only
be practiced with the right attitude in order to sustain it
and achieve the desirable goal of early diagnosis and
treatment before metastasis, which is a prerequisite for
better outcome. Breast self-examination is an important
method for the prevention of breast cancer when it is
being carried out accurately and appropriately. Breast
self-examination carried out once monthly between the 7th
and 10th day of menstrual cycle helps individuals in
detecting breast cancer at the early stages of growth when
there is low risk of spreading, ensuring a better prognosis
when treated.6,7 A woman who correctly performs BSE
monthly is more likely to detect a lump (if any) at early
stage of breast cancer development.8,9
Clinical breast examination is a breast cancer screening
method which involves a thorough physical examination
of the breast by a medical practitioner. The physical
examination include; visual inspection, palpation to
examine for breast tenderness, breast lump and axillary
lymph nodes.10 Magnetic resonance imaging as a form of
breast cancer screening method utilizes magnetic fields to
create detailed cross-sectional images of tissue structures,
providing very good soft tissue contrast.4,5,6 MRI utilizes
magnetic fields to cause changes in the movement of
protons in fat and water and creates images of the breast
by measuring the differences in tissue relaxation
characteristics. MRI may particularly be helpful in certain
situations. The use of MRI for breast cancer detection is
based on the concept of tumor angiogenesis or neo-
vascularity.11
There are several factors that can influence breast cancer
screening behaviour, these factors include; lack of
knowledge about where to go for screening,
inconvenience, cost of screening, feeling embarrassed to
seek such service, worry, fear of the screening outcome,
unwillingness to adhere to doctors’ recommendations,
fear of pain from the screening procedure, provider
unavailability, cultural beliefs about fate, the absence of
support from friends; family members and spouse,
absence of signs of breast tumour, unavailability of
screening facilities. Others are not knowing the breast
self-examination technique, not trusting one’s own
examination, concerns about lack of recognition, and
forgetting the schedule of BSEs.12-14 In addition,
socioeconomic status, distance of screening facilities, age
of the individual, health and disability, lack of breast
cancer awareness, stigmatization, beliefs about breast
cancer, religion and unemployment can also influence
breast cancer screening.15,16 Women of higher
socioeconomic status participate more in breast cancer
screening programmes than women of low
socioeconomic status.15,16
The access factor is a multidimensional concept based on
five major dimensions which are; availability of health
facilities, accessibility of care facilities, affordability of
health services, accommodation and acceptability.17
Availability and accessibility are spatial in nature.
Availability is about the handiness of health care facilities
and the adequacy of supply of health care providers while
accessibility is about travel barriers to health care
facilities and health care providers. The travel obstacles
include; travel distance to health facilities, cost and
duration. When the locations of the breast cancer
screening sites are not accessible for women, especially
those living in low-income countries, they will not
develop the interest of subjecting themselves to breast
cancer screening. For example, most mammography
screening centres are located in far areas and they are not
accessible for people living in rural areas.17,18 Fear of
costs of screening has been an obstacle to participation in
screening programme among women with low income.19
Most women who are unemployed do feel unwilling to
ask for financial assistance from their husband and kids to
go for screening.20,21,22
Language barrier is also one of the factors that determine
the participation of individuals in screening programme.
Many women face significant language difficulties when
they access health facilities, including seeing practitioners
and attending a mammography screening programme.
This barrier can keep women away from learning about
programmes for the early detection of breast cancer. Some
women, who do not understand certain general language
perfectly, find it difficult to explain their health concerns
to their health care providers in deep detail. Many also
lacked confidence about seeking help from health
professionals as they are confused by medical

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terminologies. Most require an interpreter to explain their
concerns to the providers and to understand what the
providers’ offers are.23
There are some benefits of participation in breast cancer
screening and these include early detection of breast
cancer. Treatment for early-stage cancer is mild with less
complication and higher rates of successful treatment.
Successful treatment will prevent the occurrence of
advanced cancer.1 In Nigeria, like other underdeveloped
countries, breast cancer cases are characterized by late
presentation of patients at advanced stages of the illness
when nothing rewarding can be done in order to prevent
the death of the patient.24,25 Female secondary school
teachers play a very important role in creating basic
awareness about breast cancer screening among the
younger generation. Previous school-based studies
highlighted the knowledge and practice of breast cancer
screening among female secondary school teachers.3,26
This study sought to examine breast cancer screening
behaviour among female secondary school teachers in
Rivers State.
METHODOLOGY
This was a descriptive survey conducted in secondary
schools in Rivers State, Nigeria. Rivers State is one of the 6
states in the south-south region of Nigeria. There are both
government owned and privately owned secondary schools
in Rivers State spread across the local government areas
(LGAs). The study population were female teachers in
government secondary schools in Rivers State. Ethical
approval and a letter of introduction was obtained from the
Department of Human Kinetics Health and Safety Studies,
Ignatius Ajuru University of Education, Rumuolumeni, Port
Harcourt.
A minimum sample size of 381 was derived for the study
using Taro Yamane formula27 as follows:
Sample size, n = N/((1+Ne2))
Where N = Population size = 7939
e = precision/level of significance = 0.05
n = 7939
1 + 7939(0.05)2
= 380.8130 ~ 381
A multistage sampling technique which included cluster
sampling technique, simple random sampling technique
and purposive sampling techniques was used to select
respondents. In the first stage, the study area was clustered
into two (upland and riverine area). Upland area had
fourteen (14) LGAs and four hundred and forty (440)
government secondary schools with six thousand, eight
hundred and twenty-four (6,824) female teachers. The
riverine area consisted of nine (9) LGAs and one hundred
and forty-six (146) government secondary schools with
one thousand, one hundred and fifteen (1,115) female
teachers. In the second stage, five (5) LGAs were
randomly selected from each of the clustered areas
through balloting (with non-replacement method). The
selected LGAs were Tai LGA, Ahoada West LGA,
Obio/Akpor LGA, Etche LGA, Ikwere LGA, Ogu Bolo
LGA, Okrika LGA, AkukuToru LGA, Abua/Odual LGA
and Degema LGA. In the third stage, all the female
teachers in the government secondary schools in each of
the selected LGA, who were capable of responding and
who gave consent to participate were selected. This
eventually resulted in a final sample size of 720.
Permission was sought to carry out the research through
the letters to the heads/principals of the schools. The
instrument for data collection was a semi-structured
questionnaire titled Examination of Breast Cancer
Screening Behaviour Questionnaire (EBCSBQ). The aim
and procedure of the research was explained to the
teachers and consent obtained from them before
administering the questionnaires. The questionnaire was
administered directly to the respondents by the researcher
with the help of two experienced research assistants.
Instructions regarding the filling of the instrument were
intensively explained to the respondents, and the filled
instruments were collected on the spot. A total number of
720 copies of questionnaire were administered and
retrieved with a return rate of 100%. It took an hour to fill
a questionnaire, and two and half months to gather data.
The data collected were entered into a spreadsheet and
cleaned for easy analysis, it was then transferred to IBM
SPSS Statistics version 21 for descriptive analysis and
results presented using percentages.

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RESULTS
Table 1 shows that generally, majority of the respondents
practiced breast cancer screening to a low extent (52.2%).
Only 47.2% of the respondents did perform breast self-
examination 7-10 days after their menstrual cycle, 51.3%
had never performed breast self-examination ever, and
50.7% had not gone for clinical breast examination for
breast cancer detection. Also, 53.5% of the respondents
never had a mammography. Thus, overall female
secondary school teachers in Rivers State had poor breast
cancer screening behaviour.
Table 1: Screening behaviour of female secondary school teachers
S/N
Screening Practice
Yes
No
Population
Verdict
1
Have you ever performed a breast self-examination?
351 (48.7%)
369(51.3%)
Low Extent
2
Do you practice breast self-examination 7-10 days after
your menstrual cycle?
340(47.2%)
380(52.8%)
Low Extent
3
Have you ever gone for clinical breast examination for
breast cancer detection?
355(49.3%)
365(50.7%)
Low Extent
4
Do you go for clinical breast examination once every three
years?
350(48.6%)
370(51.4%)
High Extent
5
Do you go for clinical breast examination annually?
351(48.7%)
369(51.3%)
Low Extent
6
Have you ever had a mammography screening?
335(46.5%)
385(53.5%)
Low Extent
7
Did you have mammography at least once in three years?
329(45.7%)
391(54.3%)
Low Extent
Population Screening Behaviour
47.8%
52.2%
Poor
DISCUSSION
The findings of the study in Table 1 indicated that
secondary school female teachers in Rivers State had poor
breast cancer screening behaviour. The findings of this
study were not expected, thus surprising because the
respondents were expected to have a good screening
behaviour due to their educational status. The findings of
this study are similar to that of Parsa et al,28 who carried
out a study on factors associated with breast self-
examination among Malaysian female teachers who had
a low rate of practice of breast self-examination. Only
19% of the women performed BSE regularly. Izanloo et
al29 conducted a study on knowledge and attitude of
women regarding breast cancer screening test in eastern
Iran and found that the attitude of Iranian women towards
breast cancer screening was poor and the lack of
knowledge of the respondents was the main barrier to
their participation in breast cancer screening practices.
More than 84% of the respondents were not well informed
about breast cancer and its screening tests. Korkut,30
undertook a study on assessment of knowledge, attitudes,
and behaviours regarding breast and cervical cancer
among women in western Turkey and found that almost
all the women (95.5%) had inadequate frequency of
performing screening tests. Birhan et al,9 conducted a
study on practices of breast self-examination and
associated factors among female Debre Berhan university
students and found that the respondents had poor
screening behaviour. Nde et al,31 reported on the
knowledge, attitude and practice of breast self-
examination among female undergraduate students in the
University of Buea, where majority of female students did
not practice breast self-examination as a screening
method for early detection of breast cancer. They also
found that majority of the female students had never been
to any health facility for clinical breast examination; only
3% performed BSE regularly.
The findings of the study differ from that of Sreedharan
et al32 who conducted a study on breast self-examination:
knowledge and practice among nurses in United Arab
Emirates, where the nurses had a satisfactory knowledge
(96.1%) of BSE and this was reflected in their practice of
BSE. A high proportion (84.4%) of the respondents,
reported performing BSE. Yakubu et al33 undertook a
study on knowledge, attitudes, and practice of breast self-
examination among female nurses in Aminu Kano
teaching hospital, Kano, Nigeria, where the nurses were

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aware of breast self-examination, with 91.2% practicing
it, but there was appallingly poor knowledge of its
method, timing, and frequencies among the female
nursing staff included in the study. The variation between
the finding from this study and that of Sreedharan et al32
and Yakubu et al33 could be due to the profession of the
respondents who were nurses, and nurses are likely to
have more knowledge on general health than teachers.
CONCLUSION
Based on the findings of the study, it was concluded that
female secondary school teachers in Rivers State had poor
breast cancer screening behaviour.
AUTHOR CONTRIBUTIONS
Author IME designed the study and wrote the protocol
which was reviewed by all authors; led data collection and
analysis and wrote the initial draft of the manuscript.
Authors MAK and KPL managed literature search and
attended all manuscript revisions. All authors read and
approved the final draft.
CONFLICT OF INTEREST
The authors declare that there is no conflict of interest.
FUNDING
This research received no specific grant from any funding
agency in the public, commercial or not-for-profit sectors.
ETHICAL APPROVAL
Ethical approval was obtained from the Department of
Human Kinetics Health and Safety Studies, Ignatius
Ajuru University of Education, Rumuolumeni, Port
Harcourt.
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