ASSESSMENT OF MAMMOGRAPHY SCREENING AMONG FEMALE TRADERS

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ASSESSMENT OF MAMMOGRAPHY SCREENING AMONG FEMALE TRADERS

CHAPTER ONE

INTRODUCTION

Background of the study

Breast cancer is a leading cause of death among women, and according to the World Health Organisation (WHO) there will be a significant increase in the incidence of breast cancer in developing countries such as Nigeria by 2030. However, mammography screening can significantly reduce the mortality and morbidity of women as a result of breast cancer. Therefore, the aim of this review is to evaluate the mammography screening program in Nigeria, compare it with four developed countries and then draw inferences.

The Nigerian screening program was evaluated using the following factors: – mode of invitation, frequency of screening, age of the participants, image projections, imaging staff, quality assurance program, and availability. Similarities exist between Nigeria and four developed countries (the United States of America, United Kingdom, Australia and Canada), for instance trained Radiographers do the imaging and the image projections obtained are the same. However, important differences exist, these include mode of invitation, financial model, quality assurance program and availability.

On comparison with the four developed countries, various issues have been identified within the Nigerian breast screening programmes. No one simple solution can be offered to address these as the challenges are multi-factorial.

Low and middle income countries (LMICs) are experiencing increasing incidence and mortality from breast cancer, a trend projected to continue over the next few decades (Ferlay, Shin et al. 2010). Over the past two decades, there has been a remarkable increase in the incidence of breast cancer from 33.6 per 100,000 in the 1990s to 64.6 per 100,000 after about two decades making breast cancer the most common female malignancy in Nigeria (Adebamowo and Adekunle 1999, Jedy-Agba, Curado et al. 2012). The majority of women present with advanced disease (Adesunkanmi, Lawal et al. 2006), making breast cancer one of the leading causes of cancer death.(Akinde, Phillips et al. 2015).

While outcomes remain poor in most LMICs, developed nations have demonstrated remarkable improvements in breast cancer survival. In Nigeria, breast cancer five year survival rates range from 11– 25% compared to 90% in the United States of America (Arowolo, Akinkuolie et al. 2010) (Edwards, Noone et al. 2014, Makanjuola, Popoola et al. 2014). This difference has been partly attributed to early detection as well as widely available adjuvant treatment modalities in developed countries like the USA (Berry, Cronin et al. 2005). In Nigeria, as well as most LMICs, adjuvant treatments such as radiation therapy and targeted therapy are not widely available or are unaffordable. Surgical treatment therefore remains the most common treatment with chemotherapy, when affordable. Although improving adjuvant treatment would be ideal, maximizing the benefit of surgical treatment through early diagnosis should be the initial focus, surgery being cheaper and more widely available (Groot, Baltussen et al. 2006). Mammography is the gold standard for breast cancer screening in developed countries with some evidence showing improved survival particularly among women 50–69 years in some randomized controlled trials in developed countries where breast cancer prevalence is high (Fletcher and Elmore 2003, Nystrom, Bjurstam et al. 2017). Whether the same benefits will be recorded in parts of the world with lower prevalence of breast cancer however remains contentious. In the United States, Women with average risk of breast cancer are recommended to undergo annual screening mammography starting at age 45years up to age 54 years after which they should transition to biennial screening or continue screening annually (Smith, Andrews et al. 2016). It is also recommended that women between ages 40 and 44 years should have the opportunity to begin annual screening. Nigeria currently has no National breast cancer screening guideline, as such screening recommendations are made based on international guidelines. Reports from various parts of Nigeria show very low mammography screening uptake (Okobia, Bunker et al. 2006, Akhigbe and Omuemu 2009, Obajimi, Adeniji-Sofoluwe et al. 2011, Akande, Olafimihan et al. 2015). While lack of geographic access may be suggested as a factor limiting uptake in areas with no mammography services, reasons for poor uptake in places with geographic access are not well understood. A possible explanation is lack of financial access, given that health costs are largely out of pocket with less than 5% of the population covered by the National Health Insurance Scheme (Okoronkwo, Ejike-Okoye et al. 2015) (Okebukola and Brieger 2016). There are reasons however, to believe that other factors aside cost contribute significantly to poor mammography uptake given that other forms of inexpensive or free screening similarly demonstrate poor uptake (Gharoro and Ikeanyi 2006, Okobia, Bunker et al. 2006). Understanding the drivers of poor mammography screening is therefore key for planning an effective breast cancer screening and interventional programme. The purpose of this study is to identify barriers to mammography screening uptake in Nigeria by surveying two communities with different geographical access to screening facilities.

Statement of the problem

There may have been previous researches in this subject. This work gives further explanations and analysis in assessment and knowledge of mammography examination among female traders

Objectives of the study
To understand the impact of assessment and knowledge of mammography examination among female traders
To understand the relationship between assessment and knowledge of mammography examination among female traders

Research questions
What is the impact of assessment and knowledge of mammography examination among female traders
What is the relationship between assessment and knowledge of mammography examination among female traders