# Introduction lobally in a publication by World Health Organization (WHO) (2016) breast cancer screening is an important practice in preventing breast cancer. Breast cancer is reported to be the second most common cancer in the world and, by far, the most frequent cancer among women with an estimated 1.67 million new cancer cases diagnosed in 2012 (25% of all cancers) (WHO, 2014). It ranked as the fifth cause of death from all cancers and the second most common cause of female cancer-related mortality worldwide (WHO; 2014; Abdel-Aziz et al., 2017; Diab et al., 2018). Studies have shown a reduction of breast cancer screening has a steady increase in the incidence of breast cancer in Nigeria from15.3per 100,000 in 1976 to 33.6 per 100,000 in 1992 to 52.1 per 100,000 in 2012 (Cancer Research, 2017; Olasehinde et al., 2017;Hanson et al., 2019;El Bcheraoui et al., 2015). Globally, there is a regional variability in the incidence rates of this disease ranging from 27 per 100 000 in African and Middle Eastern countries to 96 per 100 000 in Western Europe and it is, also, the most frequent cause of cancer mortality among women in the less developed regions and the second in the developed countries (Aminisani et al., 2016;National Cancer Institute, 2019;WHO, 2013). In developed countries, however, mortality from breast cancer has been on the decline despite the higher incidence of breast cancer. This is a result of early detection through organized screening programs and effective treatment modalities (Olasehinde et al., 2017;Hanson et al., 2019;El Bcheraoui et al., 2015). Breast cancer mortality has fallen considerably after the introduction of breast cancer screening in the western countries (WHO, 2013;Cancer Research, 2017). However, the screening is unavailable or less utilized (if available) in the developing countries where the majority of breast cancer deaths are occurred (Pierz et al., 2020;WHO, 2019;Keten et al., 2014;Aminisani et al., 2016). There is growing evidence that the knowledge of breast cancer screening is more aggressive in Nigeria than in the United States and Europe, including an earlier age of onset and a higher incidence of basal-like and HER2-enriched subtypes of the disease (Ojewole et al., 2017;Sung et al., Rosenberg & Jemal, 2019;Keten et al., 2014). When detected early and treated promptly, these cancers have a high cure rate in a well-resourced high-functioning health system (Pruitt et al., 2020). The aetiology of breast cancer is not well known (American Cancer Society, 2018). However, several risk factors have been shown to impact an individual's risk of developing breast cancer and their ultimate prognosis. These well-established risk factors include older age, family history, oral contraceptives, null parity, hormone replacement therapy, and early menarche, late first fullterm pregnancy, late menopause, dense breast tissue, and tobacco smoking (Sung, Siege, Rosenberg & Jemal, 2019; Diab et al., 2018). Breast cancer is curable when detected at an early stage. Women with early stage disease have an excellent prognosis with a 100% five years survival rate for stage 0 and I, while those with metastatic disease at diagnosis have a five years survival of around 20%, so it is important for women to be aware of the importance of early detection through screening (Diab et al., 2018). According to a report by Federal Ministry of Health in Nigeria (2015) early recognition and detection of Breast Cancer can play a significant role in reducing cancer morbidity and mortality as it gives more treatment options and increases survival rate if diagnosed early. Early detection of BC can be achieved by one of the following screening methods: breast selfexamination (BSE), clinical breast examination (CBE), and mammography (Breast Cancer Now, 2019; Cancer Research, 2017; American Cancer Society, 2017). Although BSE alone is inadequate for early detection of BC, it is recommended by the American Cancer Society as an option for women starting from the early 20s of age as a method for breast awareness and early recognition and detection of BC. Unlike mammography and CBE, BSE does not require hospital visit and expertise, and it is cheap, simple, and non-invasive method that can performed by women themselves at home (Agodirin et al., 2017). According to American Cancer Society (2018) recommendations, women should be aware how their breasts usually feel and report any breast changes without delay to their healthcare providers. Several previous studies have shown that female students had poor awareness and negative attitudes concerning BC and BSE. Such negative indicators continue to be present as a recent descriptive study among women in a community found that those women to have inadequate knowledge regarding BC and BSE (45.5%), fairly positive attitudes (56.3%), and low frequent practice of BSE (37.5%) (Ojewole et al., 2017;Nwaneri et al., 2017;Cancer Research, 2017;Denny et al., 2012). Worldwide, many interventional studies have been conducted to increase knwoeldge of BC screening and practice of BSE among women (Keten et al., 2014;CDC, 2019;Anderson et al., 2018). For instance, a study by Abdel-Aziz et al (2017) evaluated the effectiveness of a breast health awareness program on knowledge of BC and BSE practice among women in Rural Nigeria based on the health belief model. The study revealed that the educational intervention had a positive impact on increasing BC knowledge among the participants. Similar findings were revealed among some young Nigerian women and Saudi women (Abdel-Aziz et al., 2017). Therefore, all recommendations were to increase the level of the women's knowledge about BC and emphasize the importance of increasing BC awareness and promoting the practice of BSE for early detection of breast abnormalities (Hanson et # b) Study Design This study adopted a cross-sectional study using a quantitative method of data collection on the knowledge and practice of breast cancer screening among women at Enugu South. # c) Study Population The study population for this study consisted of adult women aged 15 years at Enugu South LGA. The estimated population of women is 11,407. # d) Inclusion Criteria This study includes; i. All women aged 15 years and above at Enugu South who gave in their consent for the study. ii. Any individual who volunteered to provide information vital to the research among women at Enugu South. # e) Exclusion Criteria This study excludes; i. Any woman aged 15 years and above at Enugu South who refuses to give in her consent for the study. ii. Any woman aged 15 years and above at Enugu South who is sick, psychologically malnourished, disabled and on admission to the hospital during the time of data collection of the study. # f) Sample Size The sample size for this study is 406 (see appendix A) g) Sampling procedure A multistage random sampling technique was used. The procedure was as follows: Stage 1: Selection of Communities; Simple random sampling was used to select 5 Communities from the total number of communities in Enugu South LGA. Stage 2: Selection of Villages: Two villages each were selected from each of the five selected communities. Also Systematic random sampling was once more is used to select households on each street to give every household an equal chance of selection. This would be done by the researcher. Finally, simple random sampling was used to select 3 females of reproductive age (15years and above) in each household giving a total of 406 respondents. # h) Instrument for Data Collection A self administered semi structured questionnaire was used for the study on the knowledge and practice of breast cancer screening among women at Enugu South. The questionnaire was designed for simplicity and assimilation by the respondents. # i) Validity of the Instrument The research instrument being the questionnaire which was used for data collection was developed by researcher and submitted to the project supervisor as well as two experts from department of public health for face validity and proper scrutiny in order to ensure that the questionnaire met the objectives of study. # j) Reliability of Instrument Reliability of the instrument was determined using test retest method. Copies of the questionnaire were given to some women outside the area of study by the researcher because this area for reliability testing shared similar characteristics with Enugu South LGA that was used for the study. Chrombach alpha test was used to test for the reliability coefficient of the questionnaire. # k) Method of Data Collection Data was obtained using a self administered based semi structured questionnaire. This was done with the aid of Two (2) field assistants who were Hired and trained to aid the researcher in the data collection process. The purpose of the research was explained face to face to the respondents before distribution of the questionnaires to them. # l) Method of Data Analysis The Statistical Package for the Social Sciences (SPSS) was used in the analysis of the data gotten from the study. Results were expressed in percentages, frequencies, tables and charts (Descriptive Statistics). Chi square test was then used to analyze the hypothesis of the study p = (0.05). # m) Ethical Consideration A letter of introduction and ethical clearance was obtained from the Department of Nursing Sciences, University of Nigeria Nsukka before the research was conducted. The purpose of the research was explained to each respondent and verbal informed consent obtained from them before inclusion into the study. Also, anonymity of the respondents was also assured and ensured. The confidentiality of the information they gave was also be maintained. # III. # Results A total of Four hundred and six (406) copies of questionnaires were distributed for the study and three hundred and ninety-six (396) questionnaires were retrieved and they were properly filled and crosschecked for correctness and were used for the purpose of the analysis. # a) Socio-demographic Characteristics From table 1 below, it was posited that 34.0% (135) of the women represented age groups between 45-49, 30.3% (120) of the women were 50 years and above, 21.4% (85) of the respondents were 35-44 years of age, 8.2% (32) were aged 25-34, and 6.1% (24) aged 15-24 years. 63.2% (250) of the women were of Igbo origin, 29.1% (115) reported 'others', 5.1% (20) Yoruba, and 2.7% (11) Hausa/Fulani. 66.9% (265) of the respondents were Christians, 14.7% (58) listed religions not included in the options but label 'others', 11.4% (45) Traditional and 6.9% (28) Muslim. 35.9% (142) of the women had a child, 8.9% (35) had two children, 26.6% (105) had 3 children and above, and 28.7% (113) had no children. Concerning the education level of the respondents, 39.0% (154) had attained tertiary education, 28.9% (115) for secondary education levels, 22.1% (88) had attained primary education levels and just 9.9% (39) had informal education levels. Students among the respondents totaled 24.7% (98), 25.2% (100) were civil servants, 23.9% (95) 'farmers', 5.9% (23) identified as traders, and 20.3% (80) 'others'. 35.8% (142) reported 'yes' concerning monthly income satisfaction, while 64.2% (254) of the women said "no". 42.8% (169) of the respondents were single, 35.2% (139) married, 16.5% (65) separated, and 5.6% (22) widowed. When the women were asked about their household level of income, 16.5% (65) reported income above 100,000, 20.9% (83) between 2,000-10,000, 10.2% (40) earned from 11,000-30,000, 2.9% (11) 1-1,000, 19.9% (79) listed 'other' income levels, 18.6% (74) earned figures from 61,000-100,000, and 11.0% (44) from 31,000-60,000. 47.4% (188) of the respondents affirmed they had a health plan at a healthcare center, while 52.6% (208) reported they did not. 1. below), 23.0% (87) of the respondents reported 'newspaper/magazines' as their sources of information on breast cancer screening, 19.0% (75) said "Tv/radio programs", 18.9% (75) reported social media, 3.8% (15) health practitioners, 14.9% (59) parents/family, 11.4% (45) school, and 9.0% (36) reported sources not listed but label 'others'. 40.3% (159) of the women affirmed they had been part of a breast cancer screening, 32.5% (129) reported 'no', and 27.3% (108) were not sure. Respondents who accepted to have undergone breast cancer screening reported to have done so between 6 months to a year (26.4%), 24.4% (39) reported 'longer than a year', 21.9% (35) said "4-6 months", 14.8% (23) reported 2-3 months, and 12.6% (20) reported in less than a month. 52.5% (208) of the women affirmed that mammography is a method used to screen for breast cancer, while 47.5% (188) replied "no". Women in Enugu-South accepted that breast self examination is encouraged as part of a breast education program, while 15.3% (60) said "no". When the respondents were asked if lump swelling under armpit, bleeding or discharge and nipple retraction is a warning sign of breast cancer, majority agreed (78.8%), while 21.2% (84) reported otherwise. 3 below, majority of the respondents reportedly demonstrated their approval to undergo breast cancer screening if offered a chance (92.5%), while 7.5% (30) denied. 53.9% (214) of the respondents reported 'Yes" when they were asked if they had been advised by a physician to screen the breast prior to the time of this investigation, 26.4% (105) could not remember, and 19.7% (78) said "No". 47.0% (186) of the respondents had not screened for breast cancer or any infection relating to the breast before filling the questionnaire, 36.3% (144) replied "Yes", and 16.7% (66) reportedly could not remember. 32.7% (47) of the respondents who reported 'yes' said they last screened for periods longer than a year, 24.6% (35) reported 4-6 months ago, 18.1% (26) said "6 months to a year", 16.6% (24) reported 'in less than a month', and 8.0% (12) reported 2-3 months ago. When they were asked concerning reasons for breast cancer screening, over half of the women (57.3%) reported 'for prevention', 18.1% (26) explained that they were presented with symptoms, 16.6% (24) just decided to go for the examination, and 8.0% (12) as a result of cases in the family respectively. 85.4% (338) of the women had never had an abnormal test result in breast cancer screening, while 14.4% (58) reported 'Yes'. # AWARENESS OF BREAST CANCER SCREENING # e) Association between the knowledge of Breast cancer screening and the Socio demographic characteristics of females Table 5 below showed the results for the test of a statistically significant association between sociodemographic characteristics and knowledge of breast cancer screening among women in Enugu South Local Government Area, Enugu State. There was a statistically significant association between age of women and knowledge of breast cancer screening (p= 0.010). Given the association between marital status of women and knowledge of breast cancer screening among women in the study population (p=0.300), there was no significant association. On the hypothesis between number of children (parity) and knowledge of breast cancer screening among women in primal population, There was also a statistically significant association (p=0.0008). Given the association between level of income of women and knowledge of breast cancer screening in the study population, there was a statistically significant association (p=0.0092). There was a statistically significant association between level of education and knowledge of breast cancer screening in the study population (p=0.0327). Finally, there was no statistically significant association between occupation and knowledge of breast cancer screening in the study population (p=0.127). Table 5: Association between the knowledge of Breast cancer screening and the Socio demographic characteristics of females f) Association between the knowledge of Breast cancer screening and the Practice of breast cancer screening among women at Enugu South Table 6 below showed the results for the test of a statistically significant association between knowledge of breast cancer screening and practice of breast cancer screening among women. There was a statistically significant association between good knowledge and practice of breast cancer screening among women (p= 0.0032). IV. # Discussion Findings of this study respect to the socio demographic characteristics of the respondents, 34.0% of the women were in the age range of 45-49 years and this is comparable to findings of Ogunkorode et al. (2017) which showed that 35% of the population studied was between the ages of 45-49 years. Also, observation from this study showed that majority of the participants in the breast cancer screening survey were Christians et al. (2015) where majority, of the respondents had good knowledge about breast cancer. However this as in contrast to the level of knowledge reported among students in Turkey where low knowledge level was reported (Hanson et al., 2019). In the study, 23.0% of the women listed newspaper/magazines as their source of information on breast cancer screening. This could be due to some campaigns and awareness on breast cancer screening on mainstream media. Additionally, 40.3% of the respondents had reportedly undergone breast cancer screening. This is however in contrast with a study by Aminisani et al. (2016) Knowledge and Practice of Breast Cancer Screening Among Women in Enugu South, Nigeria corroborate this finding and this is also in agreement with the finding of Akande et al. (2015) where majority of the students were well informed about mammography as a screening method for breast cancer. This was also observed by Kami?ska et al. (2015) and finding is similar to the results of another study conducted. From the study 92.5% of the women demonstrated their approval to utilize breast screening services if offered a chance these points out the lack of access towards breast cancer screening among respondents. A previous study by Diab et al. (2018) suggested similar findings among respondents in a Kenyan study. 53.9% of the women accepted they had been advised by a physician to screen the breast prior to the time of this investigation. A study by Poehls (2019) corroborates this finding and demonstrated that physicians actively sensitized their female patients on breast cancer screening. This study revealed that 85.4% of the women had never had an abnormal test result in Breast cancer screening as supported by several studies (Kanaga et al., 2011;Karabay et al. 2018;Al-Hussami, 2014). The finding of the study revealed that the commonest factor affecting their practice of breast cancer screening was 'distance to facility' (19.3%). This goes in consistence with a study by Poehls (2019) on the practice of breast cancer screening screenings. Another study by Hedge et al. ( 2018) in agreement to this finding and suggests that 26.6% of women who underwent breast cancer screenings listed affecting factors such as financial constraints, followed by distance to facility. Findings from this study regarding the association between Socio-demographic characteristics and practice of Breast cancer screening among women revealed that Age is significantly associated with practice of breast cancer screening screening among women(p = 0.010). Study shows that older women groups utilized breast cancer screening relative to younger groups. This goes in line with a study by Hedge et al. (2018) which found age to be associated with practice of breast cancer screening (p = 0.00271). Further investigation into the study demonstrated that marital status is not significantly associated with the practice of breast cancer screening (p = 0.300). This goes in line with a report published by Al-Amri (2015) that there was no significant association. This implies that women who wanted to utilize screenings did, irrespective of their marital status. Although certain studies suggested some women did not participate in screening exercises due to permission/acceptance from their husbands (Chigbu et al., 2017;Nnebue et al., 2018). Also, from the study among women in Enugu South, it was posited that there was a significant association between number of children (Parity) and practice of breast cancer screening among women in the study population (p =0.0008). Few studies support this finding (Adejumo et al., 2018;Chigbu et al., 2017;Nnebue et al., 2018;Olasehinde et al., 2017). Considering the hypothesis between level of income of women and practice of breast cancer screening, there a significant association (p =0.0092). This goes in consistence to a previous study by Al-Amri (2015). This signifies that women with better level of income were more likely to utilize breast cancer screening services. This study also indicates that women with higher level of education were significantly involved in breast cancer screening than those with low levels of education. Women without any formal education level hardly came in for screening. This indicates that more enlightened a person is, the more likely they were to undertake breast cancer screenings. Hence level of education of women and practice of breast cancer screening are significantly associated (p = 0.0327). A preceding study by Al-Amri (2015) confirms this finding. Findings of this study showed an association between knowledge of breast cancer screening and practice of breast cancer screening among female women(p= 0.00532).This implies that women who were well informed know the importance and would easily seek breast cancer screening as opposed to those who lacked information. A study by Poehls (2019) corroborates this finding on the association between knowledge of breast cancer screening and practice of breast cancer screening. V. # Conclusion Breast cancer is a major health concern and remains the most common malignancy in women worldwide. In this study, It was seen that age, educational level, level of income, marital status and knowledge were all related with practice of breast cancer screening among the women in Enugu South. Findings from this study establish that even though a number of women showed considerable knowledge of breast cancer screening, several others were deficient of relevant information. Women need to be encouraged to perform BCS regularly and earnestly report any abnormality to the health care providers since they generally showed willingness to participate if afforded an opportunity. Also, perceived factors affecting breast cancer screening practices such as distance to facilities must be put into consideration to ease uptake. Emphasis must be made on the importance and effectiveness of breast cancer screening. Also Policies must be implemented to accommodate low income earners and encourage breast cancer screening. 1![Fig.1: Awareness of Breast Cancer Screening c) Practices of Breast Cancer Screening among Women From table3below, majority of the respondents reportedly demonstrated their approval to undergo breast cancer screening if offered a chance (92.5%), while 7.5% (30) denied. 53.9% (214) of the respondents reported 'Yes" when they were asked if they had been advised by a physician to screen the breast prior to the time of this investigation, 26.4% (105) could not remember, and 19.7% (78) said "No". 47.0% (186) of the respondents had not screened for breast cancer or any infection relating to the breast before filling the questionnaire, 36.3% (144) replied "Yes", and 16.7% (66) reportedly could not remember. 32.7% (47) of the](image-2.png "Fig. 1 :") speaking.al., 2019; El Bcheraouiet al., 2015; Agodirin et al., 2017). Early detection andprompt attention as a result of adequate knowledge andawareness about breast cancer and screening methodsgo a long way in reducing the associated high mortalityrate (Elobaid et al., 2014; Aduayi et al., 2016; Keten etal., 2014).Recent findings from a Nigerian Breast CancerStudy show that the majority of patients have advancedstage at diagnosis than has been reported in otherpopulations (Arisegi et al., 2019; Dodo et al., 2016;Akande et al., 2015). This underscores the need forsystems-level interventions to downstage breast cancerin Nigeria (Dodo et al., 2016; Akande et al., 2015; Pruittet al., 2020). The causes of late-stage diagnosis arecomplex and, in addition to aggressive molecularsubtypes, include lack of access to comprehensivescreening and preventive care as well as social andcultural factors such as alternative healing, financialconcerns, and lack of education (Breast Cancer Now,2019; Pierz et al., 2020; Akande et al., 2015). Delayeddiagnosis of breast cancer in Nigeria has been welldocumented and has a significant impact on breastcancer morbidity and mortality. Improved awarenesscampaigns and better understanding of the causes ofdelay in care is critical to develop relevant and effectivescreening measures. It is due to this that the currentstudy aimed to investigate the knowledge and practiceof breast cancer screening among women in EnuguSouth, NigeriaII.Methodsa) Study SettingEnugu South is a Local Government Area ofEnugu State, Nigeria. Its headquarters are in the town ofUwani. It has an area of 67 km 2 and a population of198,723 at the 2006 census. The postal code of the areais 400. The geographic coordinates of Enugu South isgiven as 5 o 57'40"N 8 o 42'39"E. The people of EnuguSouth are majorly farmers. Enugu South is a majorproducer of banana and plantain for the Nigerianmarket. It is known for the Christianity and Igbo 1CharacteristicsFrequency (n=396)Percentage (%)Age15-24246.125-34328.235-448521.445-4913534.050 and Above12030.3Total396100EthnicityIgbo25063.2Hausa/Fulani205.1Yoruba112.7Others11529.1Total396100ReligionChristianity26566.9Muslim286.9Traditional4511.4Others5814.7Total396100Number of Children (Parity)None11328.7114235.92358.93 and above10526.6Total396100Education levelInformal education399.9Primary8822.1Secondary11528.9Tertiary15439.0Total396100OccupationStudent9824.7Farmer9523.9Trader235.9Civil servant10025.2Others8020.3Total396100 2Variables 3VariableFrequency (n=396)Percentage (%)Do you Practice breast cancer screening if offered achance?Yes36692.5No307.5Total396100Have any physician advised you to screen the breast before?Yes21453.9No7819.7Cannot Remember10526.4Total396100 4VariableFrequency (n=396)Percentage (%)Which of the following related as possible factors affectingyour Utility of Breast cancer screeningDistance to facility8219.3Cultural related factors4210.0Family/Husband Acceptance7918.7Financial Constraints5613.3Lack of Information5813.8Religious Factors20.5Behavior of Health workers4811.3F© 2023 Global Journ als 6Practice of breast cancerknowledge of breast cancer screeningX2P-valueDecisionscreeningGood KnowledgePoor(%)Knowledge (%)Yes89.0%11.0%1.93760.0032SigNo32.8%67.2% Volume XXIII Issue I Version ID D D D ) F(Medical Research© 2023 Global Journ als ## Appendix A ## Sample size determination The sample size will be determined using the Yamene formula (1967) * MN OAbdel-Aziz GShaimaa BBaher OPAmin HTarek IRTawfik NAl-Gadeeb PMohammed NMBaqir AAlhassar IAbdullah CAl-Ramadan NAli TOAl-Helal JKMohammed DAlkhalaf Eman * GHussain Nigerian Journal of cancer prevention 18 9 2409 2017 * Awareness Of Breast Cancer Screening Among Female Undergraduate Students Of University Of Ibadan PAdejumo JAluko OOluwatosin Nigeria. African Journal For The Psychological Study of Social Issues 11 1&2 2018 * Estimating the incidence of breast cancer in Africa: a systematic review and meta-analysis BAdeloye LDavies TSowunmi YOlaperi UJacobs DWura ARotimi AAAdeosun AOAmuta NHarhay OMichael Journal of global health 8 1 2018 * A Community Based Rural-Urban Comparison of Knowledge and Perception of Women towards Breast Cancer in South Western Nigeria VAduayi MAdovi UAduayi FPOlufunso ISimisola YOnayade EAdedeji OAEsimai International Journal of Health Sciences and Research (IJHSR) 6 4 2016 * Effectiveness of Breast Cancer Education Awareness Practice among Female Students of Tertiary Institutions JAAgbonifoh Journal of Education and Practice 7 12 2016 * Patterns of breast cancer referal to palliative care and the complementary role of a palliative care unit in a resource-limited country SOAgodirin GARahman SAOlatoke AODurojaiye Postgraduate Medical Journal 6 1 2017 * A five year audit of mammography in a tertiary hospital NAkande FHalimat VJumai UTOlafimihan YBola UBamidele CJOyinloye EOlalekan OIbikun North Central Nigeria. Nigerian medical journal: journal of the Nigeria Medical Association 56 3 213 2015 * Prevention of breast cancer AMAl-Amri Journal of family & community medicine 12 2 71 2015 * Jordanian women's personal practices regarding prevention and early detection of breast cancer MAl-Hussami RZeilani OAAlkhawaldeh LAbushaika 10.1111/2047-3095.12045 International journal of nursing knowledge 25 3 2014 * The sensitivity and specificity of screening mammography in primary care setting in Saudi Arabia AAlkhenizan SHussain BAneela AAlsayed 2013 American Society of Clinical Oncology 12 * Impact of a Breast Cancer Educational Program on Female University Students' Knowledge, Attitudes, and Practices AAlsaraireh MWDarawad 10.1007/s13187-017-1304-6 2019 34 Journal of cancer education: the official journal of the American Association for Cancer Education * Breast Cancer facts and figures Recommendations for early detection of breast cancer 2018b. 2017 American Cancer Society Global Cancer Facts & Figures 4th Edition * Breast Cancer facts and figures Recommendations for early detection of breast cancer 2018 American Cancer Society * About breast cancer 2019 American Cancer Society * Determinants of breast cancer screening uptake in Kurdish women of Iran. Health promotion perspectives UAminisani ONayyereh TJ CFattahpour MRoujin NDastgiri ASaeed BMohammad HAllahverdipour 2016 6 42 * Guideline implementation for breast healthcare in low-income and middle-income countries: Overview of the Breast Health Global Initiative Global Summit BOAnderson CHYip RASmith RShyyan SFSener AEniu JHarford Cancer 113 S8 2018. 2007 * Determinants of cancer screening awareness and participation among Indonesian women SLAnwar GTampubolon MVan Hemelrijck SHHutajulu JWatkins WWulaningsih Pilar Research Network 10.1186/s12885-018-4125-z BMC cancer 18 1 208 2018 * Knowledge of breast cancer and practice of breast self-examination among female National Youth Service Corps members in a Northern Nigeria State MOArisegi ASarafadeen UGrema ABukar SSingh OAhmed OIdris FAFalaki MMBello 2019 ABOUT IAMHR 82 * Assessment of factors associated with breast selfexamination among health extension workers in West Gojjam Zone MAzage GAbeje AMekonnen International journal of breast cancer 2013. 2013 * Rising global burden of breast cancer: the case of sub-Saharan Africa (with emphasis on Nigeria) and implications for regional development: a review SOAzubuike CMuirhead LHayes RMcnally World journal of surgical oncology 16 1 63 2018 * Established breast cancer risk factors and risk of intrinsic tumor subtypes MEBarnard CEBoeke RMTamimi Biochimica et Biophysica Acta (BBA)-Reviews on Cancer 1856 1 2015 * KBirhane MAlemayehu BAnawte GGebremariyam RDaniel SAddis * Practices of breast selfexamination and associated factors among female debre berhan university students WNegash International journal of breast cancer 2017. 2017 * Comparison of digital screening mammography and screen-film mammography in the early detection of clinically relevant cancers: a multicenter study AMBluekens RHolland NKarssemeijer MJBroeders GJDen Heeten Radiology 265 3 2012 * Am i at risk of breast cancer? Understanding Breast Cancer --Prevention. How Can I Prevent Breast Cancer? Breast Cancer Care 2018a * How does breast cancer starts? Understanding Breast Cancer --Prevention Breast cancer care 2018b * BREAST AWARENESS: Know your own risk Breast Cancer Foundation 2019 * what can cause breast cancer Breast Cancer Now 2019 * Family History of Breast Cancer Dramatically Increases Risk of Cancer in Other Breast. Risk factors OrgBreastcancer 2018 * Family history and risk of breast cancer: an analysis accounting for family structure HRBrewer MEJones MJSchoemaker AAshworth AJSwerdlow Breast cancer research and treatment 165 1 2017 * Breast Cancer Factors Cancer Research 2017 * Breast Cancer. CDC website Cdc 2018a. 2018b Breast cancer * The impact of community health educators on uptake of cervical and breast cancer prevention services in Nigeria COChigbu AKOnyebuchi TCOnyeka BUOdugu CCDim International Journal of Gynecology & Obstetrics 137 3 2017 * Breast anatomy CleavelandClinic 2019 * Menarche, menopause, and breast cancer risk: individual participant meta-analysis, including 118 964 women with breast cancer from 117 epidemiological studies Collaborative Group on Hormonal Factors in Breast Cancer 13 11 2012 The lancet oncology * APCooper On the Anatomy of the Breast Longman 2011 1 * Cervical cancer in Africa ODenny JLynette RAnorlu Cancer Epidemiology and Prevention Biomarkers 21 9 2012 * SDiab IAWahdan EGawwad SSallam 2018 * Exploring the barriers to breast and cervical cancer screening in Nigeria: A narrative review AMDodo MSykes JPeter CPowell African Journal of reproductive health 20 4 2016 * Mammographic findings of breast cancer screening in patients with a positive family history in Iyienu, Southeast Nigeria UEbubedike EUmeh SAnyanwu Nigerian journal of clinical practice 21 6 2018 * Breast cancer screening in Saudi Arabia: free but almost no takers CEl Bcheraoui MWBasulaiman DShelley TFarah AMarwa AMohammad AHMokdad Plos one 10 3 e0119051 2015 * Breast cancer screening awareness, knowledge, and practice among Arab women in the United Arab Emirates: a cross-sectional survey CElobaid EYusra TAwar XChing OGrivna NMichal NNagelkerke PloS one 9 9 e105783 2014 * NJEngmann MKGolmakani DLMiglioretti BLSprague KKerlikowske 2017 * Population-attributable risk proportion of clinical risk factors for breast cancer JAMA oncology 3 9 * Breast carcinoma presentation, diagnosis, and staging: An update form the National Cancer Data Base 2015 Abuja FCT, Nigeria Federal Ministry of Health of Nigeria * Cost effectiveness of strategies to combat breast, cervical, and colorectal cancer in sub-Saharan Africa and South East Asia: mathematical modelling study GMGinsberg JALauer SZelle SBaeten RBaltussen Bmj 344 e614 2012 * breast cancer risk factors DGrande 2018 * Comparison of tomosynthesis plus digital mammography and digital mammography alone for breast cancer screening BMHaas VKalra JGeisel MRaghu MDurand LEPhilpotts Radiology 269 3 2013 * Breast selfexamination and death from breast cancer: a metaanalysis AKHackshaw EAPaul British journal of cancer 88 7 1047 2013 * Practice and Barriers of Breast Self-Examination among Women in a Rural Community in South Western VFHanson AREl-Kader TGad REIlesanmi Nigeria. International Journal of Studies in Nursing 4 3 46 2019 * Breast Cancer Risk factor awareness and utilization of screening program: A cross-sectional study among women in the Northern Emirates PHegde JPande HHAdly PShetty AJayakumari The Gulf journal of oncology 1 27 2018 * Breast cancer risk factors MKami?ska TCiszewski K?opacka -Szatan PMiot?a EStaros?awska Przeglad menopauzalny= Menopause review 14 3 196 2015 * Awareness of breast cancer and screening procedures among Malaysian women KCKanaga JNithiya MFShatirah Asian Pacific journal of cancer prevention: APJCP 12 8 2011 * Impact of breast cancer awareness month on detection of breast cancer in a private hospital OKarabay MHasbahceci HKadioglu 10.1177/030006051769 The Journal of international medical research 46 2 2018 * Breast cancer screening: a review of current mammography guidelines KarenHerold BramGoldstein JanuaryLopez 2017 * which age group are at high risk of breast cancer? JKatz ADPatel 2019 Medscape * Knowledge, attitudes and behavior about breast cancer in women presenting to Early Cancer Diagnosis HSKeten FY?ld?r?m SÜÖlmez DHüseyin MÇelik Gaziantep Medical Journal 20 3 2014 * Breast cancer screening (breast self-examination, clinical breast exam, and mammography) in women referred to health centers in Tabriz AKhalili MShahnazi Iran. Indian journal of medical sciences 64 4 149 2010 * Understanding population, health terminology DKindig Milbank Q 85 1 2017 * Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations TMKolb JLichy JHNewhouse Radiology 225 1 2002 * Radiation therapy: a major factor in the five-year survival analysis of women with breast cancer in HMakanjuola BLSamira NPopoola OAbiodun MAOludara Radiotherapy and Oncology 111 2 2014 * The benefits and harms of breast cancer screening: an independent review MGMarmot DAltman DCameron JDewar SThompson MWilcox British journal of cancer 108 11 2205 2013 * Invasive Lobular Carcinoma Mayo Clinic 2018 * Breast cancer: causes Mayo Clinic 2019 * Breast self-examination and breast awareness: a literature review TMccready DLittlewood JJenkinson Journal of Clinical Nursing 14 5 2015 * Performance and reporting of clinical breast examination: a review of the literature SMcdonald DSaslow MHAlciati CA: a cancer journal for clinicians 54 6 2014 * Socio-cognitive theory SAMcleod 2018 * A survey of breast cancer knowledge and attitude in Iranian women NNafissi MSaghafinia MH KMotamedi MEAkbari Journal of cancer research and therapeutics 8 1 46 2012 * Breast cancer screening (PDQ)-health professional version 2019 National Cancer Institute * Knowledge, attitude and practice of breast self-examination among female undergraduate students in the University of Buea FPNde JC NAssob TEKwenti ALNjunda TR GTainenbe BMC research notes 8 1 43 2015 * Breast Cancer Awareness, Knowledge and Screening Uptake among Female Secondary Schools Teachers in Owerri CCNnebue UMUmeh PCEkezie GOEkeh AIEkpe ECOkodo Nigeria. Journal of Cancer and Tumor International 2018 * ANwaneri EOOsuala PUOkpala ACEmesowum PIheanacho 2017 * Knowledge and awareness of breast cancer among rural women in Umuowa Orlu local government area Imo State Nigerian Journal of Clinical Practice 20 4 * HObajimi OMillicent MAjayi OIkeoluwapo COluwasola OAbideen FAdedokun OBabatunde KAdeniji-Sofoluwe TAdenike OAMosuro TOSoyemi Level of awareness of mammography among women attending outpatient clinics in a teaching hospital in 2013 * South-WestIbadan Nigeria BMC public health 13 1 * Promoting early detection of breast cancer and care strategies for Nigeria KAOgunkorode LHoltslander EAnonson PJune JMaree African journal of reproductive health 21 2 2017 * Factors Predicting the Utilization of Breast Cancer Screening Services among Women Working in a Private University in Ogun State MOjewole CFoluso NMuoneke Nigeria. Asian Journal of Medicine and Health 2017 * Providing universal health insurance coverage in Nigeria. International quarterly of community health education POOkebukola WRBrieger 2016 36 * Financial barriers to utilization of screening and treatment services for breast cancer: an equity analysis in Nigeria ILOkoronkwo PEjike-Okoye AUChinweuba ACNwaneri Nigerian journal of clinical practice 18 2 2015 * Developing a breast cancer screening program in Nigeria: evaluating current practices, perceptions, and possible barriers OOlasehinde CBoutin-Foster OIAlatise AOAdisa OOLawal AAAkinkuolie TPKingham Journal of global oncology 3 5 2017 * Interventions for raising breast cancer awareness in women. The Cochrane database of systematic reviews MO'mahony HComber TFitzgerald MACorrigan EFitzgerald EAGrunfeld MGFlynn JHegarty 10.1002/14651858.CD011396.pub2 2017 2 * Awareness, attitude and practice of rural women regarding breast cancer in Northeast Nigeria BOmotara SYahya MAmodu JBimba J Community Med Health Educ 2 5 2012 * Breast cancer in Nigeria: diagnosis, management and challenges EOsaro 2016 Author House * Predictors of practice of breast self-examination: A study among female undergraduates EOssai BAzuogu IOgaranya AOgenyi DEnemor MNwafor Nigerian journal of clinical practice 22 3 361 2019 of Ebonyi State University * A scoping review: Facilitators and barriers of cervical cancer screening and early diagnosis of breast cancer in Sub-Saharan African health settings AJPierz TCRandall PECastle AAdedimeji CIngabire GKubwimana FMusabyimana Gynecologic Oncology Reports 100605 2020 * Awareness of breast cancer incidence and risk factors among healthy women in Germany: an update after 10 years. European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP) UGPoehls CCHack MWunderle SPRenner MPLux MWBeckmann PAFasching NNabieva 10.1097/CEJ.0000000000000500 2019 28 * Breast Cancer Knowledge Assessment of Health Workers in Ibadan LC CPruitt SOdedina IAnetor TMumuni HOduntan AAdemola KOjengbede AOladosu JCO Global Oncology 6 2020 * Mammography * Women's perceptions of the adoption of personalised riskbased breast cancer screening and primary prevention: a systematic review LRainey DVan Der Waal YWengström AJervaeus MBroeders Acta oncologica 10 2018 * 10.1080/0284186X.2018.1481291 * JRusby RAgha Nipple and breast anatomy Operative Approaches to Nipple-Sparing Mastectomy Springer 2017 * Interventions promoting breast cancer screening among Turkish women with global implications: a systematic review NSecginli CSelda KONahcivan ONursen JGunes CPGussun RFernandez Worldviews on Evidence Based Nursing 14 4 2017 * Screening for breast cancer in 2018-what should we be doing today? JSeely TAlhassan Current Oncology 25 S115 2018 Suppl 1 * Update on breast cancer risk prediction and prevention ISestak JCuzick 10.1097/GCO.0000000000000153 Current opinion in obstetrics & gynecology 27 1 2015 * Breast self-examination and breast cancer awareness in women in developing countries: a survey of women in Buea MA BSuh JAtashili EAFuh VAEta Cameroon. BMC research notes 5 1 627 2012 * Risk factors and preventions of breast cancer Y.-SSun ZZhao Z.-NYang FXu H.-JLu Z.-YZhu H.-PZhu International journal of biological sciences 13 11 1387 2017 * Emerging cancer trends among young adults in the USA: analysis of a population-based cancer registry HSung RLSiege PSRosenberg AJemal The Lancet Public Health 4 3 2019 * Trastuzumab emtansine for HER2-positive advanced breast cancer SVerma DMiles LGianni IEKrop MWelslau JBaselga EGuardino New England Journal of Medicine 367 19 2012 * Reply to A failure analysis of invasive breast cancer: Knowledge and Practice of Breast Cancer Screening Among Women in Enugu South, Nigeria most deaths from disease occur in women not regularly screened MLWebb DBKopans BCady Cancer 120 18 2014 * Understanding Breast Cancer --Prevention. How Can I Prevent Breast Cancer? Webmd Cancer. Breast cancer Prevention and Control 2019. 2013 * Prevention And Control of Breast Cancer 2019 World Health Organization * Comprehensive cervical cancer control: a guide to essential practice: World Health Organization World Health Organization 2016 * Risk of radiation-induced breast cancer from mammographic screening MJYaffe JGMainprize Radiology 258 1 2011 * Challenges and prospects of empowering rural women in Nigeria KYaro NYakse Social Sciences & Education 2 1 2013 African Review of Arts * Breast cancer prevention strategies in lobular carcinoma in situ: A decision analysis SMWong NKStout RSPunglia IPrakash YSagara MGolshan 10.1002/cncr.30644 Cancer 123 14 2017 * What is your age range? (a) 50 2. What is your Religion? (a) Christianity [ ] (b) Muslim [ ] (c) Traditional [ ] (d) Others (Please Specify * Igbo [ ] (b) Hausa [ ] (c) Yoruba [ ] (d) Fulani [ ] (e) Others Ethnicity please specify)_____________ 4. Marital status (a) Married [ ] (b) Single [ ] (c) Separated [ ] (d) Widowed [ ] 5. Education level (a) No formal education. c) Secondary [ ] (d) Tertiary [ ] 6. Your occupation: (a) Artisan e.g Carpenter, Hairdresser, Tailor, Driver [ ] (b) Civil servant e.g Teacher. d) Unemployed [ ] (e) Professionals e.g. Doctor, Nurse, Lawyer, Accountant [ ] (f) Others (please specify * Are you satisfied with your monthly income? (a) Yes b.) 1 [ ] (c.) 2 9 Number of children (Parity) (a.) None d.) 3 [ ] (e) 4 and above. 10. Do you have a Health plan at any healthcare Center? (a) Yes [ ] (b) No [ ] SECTION B: KNOWLEDGE OF BREAST CANCER SCREENING AMONG WOMEN INSTRUCTION: Please tick (?) the correct options besides each question and also fill in the spaces provided where appropriate with the correct options * ) Health practitioner i.e nurse, doctor, auxiliary health personnel etc Have you heard about Breast Cancer Screening? (a) Yes [ ] (b) No [ ] 12. What is your source of information on breast cancer Screening? (a) School [ ] (b) Parents/family [ ] (c) Social media d) Tv/radio programs [ ] (e. f) news papers/ magazines [ ] (l) others(please specify * Mammography is a method used to screen for breast cancer (a) Yes [ ] (b) No [ ] 16. Breast self examination is encouraged as part of a breast education program (a) Yes [ ] (b) No [ ] 17. Lump swelling under armpit, bleeding or discharge and nipple retraction is a warning sign of breast cancer (a) Yes 14. When was that? (a) Not Yet [ ] (b) less than a month 15 Have you been part of a Breast Cancer Screening Program (a) Yes [ ] (b) No [ ] (c) Not Sure. c) 2-3 months [ ] (d) 4-6 months [ ] (e) 6 months to a year [ ] (f) longer than a year. b) No [ ] SECTION C: PRACTICES OF BREAST CANCER SCREENING AMONG WOMEN 18. Do you Practice breast cancer screening if offered a chance? a) Yes [ ] (b) No [ ] 19. If No to Question (25) Why? ____________________________________ 20. Have any physician advised you to screen the breast before? (a) Yes [ ] (b) No [ ] (c) Cannot Remember 21. Have you screened for breast cancer or any infection relating to the breast before? (a) Yes [ ] (b) No [ ] (c) Cannot Remember * What was your reason for the breast cancer screening? (a) Presented with symptoms [ ] (b) Cancer cases in the family c) for prevention [ ] (d) Just decided to go for the examination [ ] (f) Others (please specify * Have you ever had abnormal test result in breast cancer screening? (a) Yes