Assessment of knowledge towards breast cancer early detection methods among female health professionals in Adigrat town public health institutions, Tigray, northern Ethiopia, 2018

Objective The main objective of the study to determine breast cancer early detection method knowledge among female health professional, Adigrat, town, Tigray, Ethiopia, 2018.Result The study assessed the knowledge of health professionals. Majority of the health professionals 55.7% (60) were founded knowledgeable and 44.3% (48) were not knowledgeable.


Background
Cancer is a group of diseases characterized by the uncontrolled growth and multiply of abnormalcells.If the spread is not controlled, it can result in death (1).Breast cancer (BC) is an explosionof malignant cells that arises in the breast tissue and the term represents a range of disease, from non-invasive to invasive carcinoma (2).One of the most commonly diagnosed cancers worldwide was breast cancer which accounts 1.7 million (11.9%) of the total, and it is increasing particularly in developing countries where the majority of cases are diagnosed in late stages (3,4).Breast cancer is the rst most often occurring among women in Ethiopia.Thousands of more cases unreported as women living in rural areas often seek treatment from traditional healers before seeking help from medical centers (5) Data from the Addis Ababa population based cancer registry showed that breast and cervical cancers were the leading commonly diagnosed cancer comprising 22.6% and 10.8% respectively of all cases of cancers in Addis Ababa (6).The causes of breast cancer are not completely known.However, researchers have identi ed a number of risk factors that increase one's chances of getting breast cancer.These includes; family history of breast cancer, personal history of breast cancer, early menarche, (<12 years), late menopause (>55years), aging, excessive alcohol use, late age at rst full-term pregnancy (>30 years), never breast feeding a child, high fat diet, tobacco smoking, post-menopausal obesity, recent and long term use of hormone replacement therapy, high-dose radiation to chest and lack of physical exercises (2).
Breast cancer early detecting is the systematic application of a test in a presumably asymptomatic population.It aims to identify individuals with an abnormality suggestive of cancer.Breast cancer early detection methods include breast self-examination (BSE), clinical breast examination (CBE), and mammography.CBE and mammography require hospital visit and specialized equipment and expertise whereas BSE is an inexpensive tool that can be carried out by women themselves (7).Several studies undertaken to assess the value of mammography for early detection of breast cancer demonstrated a signi cant reduction in rates of death from breast cancer (about 25%-30%) (8).Once breast cancer diagnosed there are speci c treatment depends on stage and extent of the tumor.The main treatment options may include: surgery, radiation therapy, biological therapy (targeted drug therapy), chemotherapy and hormone therapy alone or in combination .Many studies have examined the role of female health workers in promoting breast cancer early detection methods (9,26).If this knowledge is poor among those who should teach others, there will be di culty promoting this life saving methods and it will be a contributing factor for late presentation.Addis Ababa city is selected because it accommodates people with different cultural backgrounds, norms and values and it has a considerable diversity of sociodemographic status and also according to Addis Ababa cancer registry, breast cancer incidence higher compared to other areas.Female health workers play a unique role in alerting the community to the early detection of breast cancer methods as they are usually the closest contacts with patients.
This study was designed to evaluate the knowledge, attitude and practice of breast cancer early detection methods among female health workers in Adigrat town, Tigray Ethiopia

Study design
Institution Based Cross Sectional study design was employed

Study area
Adigrat hospital is a general hospital found in the Eastern Zone of Tigray, Ethiopia.It is a referral hospital for seven (7) primary hospitals and over forty two (42) health centers and health post in the region.It refers patients to Ayder teaching and referral Hospital, the second largest hospital in Ethiopia.It has a catchment area of over one million people.It has over two hundred and eighty (280) staffs, among them three (3) consultants (general surgeon, internist and the gynecologist), six (6) general practitioners, eighty three (83) nurses and 16 midwives from those 97 of them are female health professionals.The hospital has outpatient department, maternity and gynecology wards, surgical ward, one operating theaters, general medical ward, pediatric ward, neonatal intensive care unit (NICU), maternal child health (MCH) clinic, pediatric outpatient, radiology, laboratory, health information management (HIMS), nance, facility management, and kitchen and housekeeping departments.And also from those health center there are two health center in the town Meada agama health center and Tekleswat health center both have included a total of 35 female health professionals Participant All female health professional in Adigrat town public health institutions were considered as source population.The study subjects were female health professionals who was selected and consented to participate in the study.
The sample was determined by using single population formula considering 95% con dence intervals, and 5% marginal error.On a research done to assess knowledge of breast cancer and early detection methods among nurses in university hospitals in Addis Ababa 57.8% of the participants was knowledgeable so taking P value to be 0.

Socio demographic characteristics of the study population
The participants were between the age group of 19 -65 years with a mean age of 29 years and Standard deviation of 6.559 years.By age group, over fty three of the study Participants (49.1%) were aged between 29 to 38 years.Most of the participants were married with 79(73.1%)respondents and single with 22 (20.4%)respondents.67(62%) of the study.Participants were rst degree holders.From the total study participants 64 (59.3%) of them were nurses, 10 (9.3%) were health o cers and 24 (22.2%)midwives.The average work experience of the study participants were 2.53 years with standard deviation of 1.357 years, 30(27.8%) of the participants had worked four and less years, 34 (31.5%) of the participants had worked for ve to nine years and twelve (11.1%) of the participants had worked for twenty and more years, respectively.Thirteen (12%) of them mentioned they have history of breast problem while ten (9.3%) have reported that they have family history of breast cancer.(Table1) Knowledge of female health professionals on breast cancer risk factors and sign and symptoms Among all of the participants Most of the participants 87 (80.6%) were mentioned smoking as a risk factor for breast cancer, 74 (68.5%) mentioned alcohol consumption 49 (45.4%)mentioned high fat diet, 46(42.6%)family history of breast cancer.The most commonly mentioned sign and symptom of breast cancer was discharge from the breast 65(60.1%),dimpling of the breast 64(59.3%),pain on the breast 63(58.3%),swelling of the breast 62(57.4%).(

Knowledge of respondents on breast cancer early detection methods
Among all the respondents 29(26.9%) of them mentioned BSE should be started at twenty years and 51(47.2%) of them mentioned Mammography should be started at 30 years.34(31.5%) of the respondents knew that BSE should be done monthly,9(8.3%)knew CBE should be done three yearly for women younger than forty, 27 (25%) mammography yearly.43(39.8%) of the respondents answered that appropriate time to perform BSE is one to seven days after menses.Most of the respondents 37(34.3%)knew that mammography is used for both diagnostic and early detection purpose.(Table 3)

Discussion
This study tries to assess knowledge towards breast cancer early detection methods.Knowledge of breast cancer was assessed by combining responses regarding risk factor, sign and symptoms, early detection methods and treatment option assessing questions.Work experience of study participants.Age, work experience, marital status and knowledge.In this study smoking was the major risk factor reported for breast cancer, followed by positive family history of breast problem, alcohol consumption and increasing age.Findings in this research similar with researches in Saudi Arabia and Pakistan, increasing age, positive family history of breast problem, smoking were reported as risk factor for developing breast cancer (29,34).
The majority respondents mentioned sign and symptom of breast cancer were discharge from the breast (60.1%), dimpling of the breast (59.3%) and pain in the breast (58.3%).This nding is less than the research nding in Nigeria where breast lump was mentioned by 94.6%, discharge from nipple 89.2% (22).This could be attributed to the socioeconomic difference may result in increased knowledge about breast cancer sign and symptoms due to higher level of education.
In this study from all the respondents 78.7% knew CBE as early detection method, 51.9% knew BSE and only 33.3% knew Mammography as a screening method for breast cancer.This study nding is lesser than a study done in government hospitals of Addis Ababa revealed that among female health professionals 77.6% female health professionals were aware of BSE as early detection method.CBE was mentioned as early detection method by 78.7% and the least mentioned early detection method by the participants was.Mammography which was known by 53.7% respondents (14).The difference in the result could be attributed to the fact that professionals working in hospitals have more exposure to breast cancer cases and cases are referred to hospitals for further diagnosis and treatment and also experts that have more experience and knowledge are available for consultation.The nding in this research lower than a study done in Nigeria showed that, among the respondents, 97%, 93.2%, 99% were aware of breast self-examination, clinical breast examination and mammography as early detection tools respectively (22).This could be attributed to the socioeconomic difference may result in increased knowledge about breast cancer early detection methods due to higher level of education.
In this research among all female health professionals 88% knew surgery as one of treatment Option, 58.3% knew radiotherapy as one of treatment option and 58.3% knew chemotherapy as one of treatment option for breast cancer.This study nding is higher than a research done in central Africa republic showed that among health workers 44.2% of respondent knew surgery, 22.9% of respondents knew radiotherapy and 29.7% of respondents knew chemotherapy as a treatment options.This difference may be due to cultural and socio-economic deference among these two populations (40).

Conclusions
Based on the nding of this study, the following were concluded, More than half of the health professionals were found knowledgeable regarding breast cancer early detection.strictly within the members of the group.Anonymity was maintained to ensure con dentiality of respondents.All participants were provided with Amharic language written consent and put their signature prior to participate in the study.
Limitations AAHB-Addis Ababa health bureau BC -Breast Cancer BCEDM-breast cancer early detection methods BSE -Breast Self-Examination CBE -Clinical Breast Examination KAP -Knowledge, Attitude and Practice FHW-Female Health Workers LMCs-Low and Middle Income Countries UK-United Kingdome NCR-National Cancer Registry

Table 1 :
, A. K. (2004)."Breast self-examination among nurses and midwives in Odemis health district in Turkey" PMID: 19574672.37. Central Statistics Agency of Ethiopia.2007.38.Bureau AAcaH, c. administrator, Addis Ababa, Ethiopia 2014.39.Eguvbe AO, Akpede N, Arua N E Knowledge of Breast Cancer and Need for its Screening Among Female Healthcare Workers in Oshimili South Local Government Council Area of Delta State, Nigeria AFRIMEDIC Journal Volume 5, No. 1, January -June, 2014 40.Augustin Balekouzou et al Assessment of Breast Cancer Knowledge among Health Workers in Bangui, Central African Republic Asian Paci c Journal of Cancer Prevention, Vol 17, 2016.Frequency distribution of characteristics of respondents at Public institutions in Adigrat town, Tigray, 2018.

Table 2 :
knowledge of FHP on breast cancer risk factors, sign and symptoms at public health institutions of

Table 3 :
Knowledge of respondents on breast cancer early detection methods at public health institutions inAdigrat town, Tigray, Ethiopia, 2018.