1.4 Objectives of the study
- Assess the female undergraduate students’ knowledge about the causes of breast cancer
- Determine their source of information about breast cancer
- Assess their preferred breast cancer management measures
1.5 Significance Of The Study
It will enable curriculum planners to know what should be in the secondary school health education curriculum.
It would help health education teachers to device health education materials and manuals that would improve the the teaching strategies for Breast management.
2.1 Overview of the Structure of the Breast
The female breast is made up mainly of glands that make breast milk (called lobules), ducts (small/tiny tubes that carry milk from the lobules to the nipple), stroma (fatty and connective tissues surrounding the ducts and lobules), blood vessels and lymph vessels. Most breast cancers begin in the cells that line the duct (ductile cancer), some begin in the lobules (lobular cancer), and a small number start in other tissues (Breastcancer.Org, ACS, 2020).
2.1.1 The Lymph (lymphatic) System of the Breast
The lymph system is important to understand because it is one way breast cancers can spread. This system has several parts.
Lymph nodes are small, bean-shaped collections of immune system cells (cells that are important in fighting infections) that are connected by lymphatic vessels. Lymphatic vessels are like small veins, except that they carry a clear fluid called lymph (instead of blood) away from the breast. Lymph contains tissue fluid and waste products, as well as immune system cells. Breast cancer cells can enter lymphatic vessels and begin to grow in lymph nodes. Most lymphatic vessels in the breast connect to lymph nodes under the arm (axillary nodes). Some lymphatic vessels connect to lymph nodes inside the chest (internal mammary nodes) and either above or below the collarbone (supraclavicular or infraclavicular nodes).
If breast cancer cells reach the underarm lymph nodes and continue to grow, they cause the nodes to swell and when they have spread to lymph nodes, there is a higher chance that the cells could have also gotten into the bloodstream and spread (metastasized) to other sites in the body. The more lymph nodes with breast cancer cells, the more likely it is that the cancer may be found in other organs as well. Because of this, finding cancer in one or more lymph nodes often affects the treatment plan. Still, not all women with cancer cells in their lymph nodes develop metastases, and some women can have no cancer cells in their lymph nodes and later develop metastases. (Breastcancer.Org, ACS, 2020).
2.2 Breast Cancer
Breast cancer is a malignant tumour that starts in the cells of the breast. A malignant tumour is a group of cancer cells that can grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body.
Types of Breast Growth
Benign Breast Growth: Most breast lumps are benign (not cancerous). Benign breast tumors are abnormal growths, but they are not cancerous and do not spread outside the breast to other organs. They are not life threatening. Still, some may need to be biopsied (sampled and viewed under a microscope) to prove they are not cancer. Most lumps turn out to be caused by fibrosis or
cysts, benign changes in the breast tissue that happen in many women at some time in their lives. (This is sometimes called fibrocystic changes and used to be called fibrocystic disease.) Fibrosis is the formation of scar-like (fibrous) tissue, and cysts are fluid-filled sacs. These conditions are most often diagnosed by a doctor based on symptoms, such as breast lumps, swelling, and tenderness or pain. These symptoms tend to be worse just before a woman’s menstrual period is about to begin making breasts feel lumpy sometimes, a clear or slightly cloudy nipple discharge may be noticed. Some benign breast conditions are important because women with these conditions have a higher risk of developing breast cancer. (Breastcancer.Org, ACS, 2020).
Malignant Breast Growth: breast cancer is a malignant growth that starts in the cells of the breast. breast cancer starts when the process that controls normal cell growth breakdown, enabling a single abnormal cell to multiply at a rapid rate (ACS, 2020). Every person has a cancer cells in the body. These cancer cells do not show up in the standard tests until they have multiplied to a few billion. When doctors tell cancer patients that there are no more cancer cells in their bodies after treatment, it means the tests are unable to detect the cancer cells because they have not reached the detectable size. Cancer cells occur between six to more than ten times in a person’s life time (James, 2005).
2.3 Causes / Etiology of breast cancer
The cause of breast cancer is still unknown. However, some risk factors can determine a woman’s chances of developing breast cancer. Some women who have one or more risk factors never get breast cancer while most women who do get breast cancer do not have any risk factors (ACS, 2020).
Breast cancer Risk Factors
A risk factor is anything that affects your chance of getting a disease, such as cancer.
There are some risk factors that can not be changed such as a person’s age or race. They are known as non-modifiable risk factors. Others are linked to the environment. Still, others are related to personal behaviours such as smoking, drinking and diet. They are known as modifiable risk factors (ACS, 2020).
Breast Cancer Non-modifiable risk factors
Being a female (Gender): Simply being a woman is the main risk factor for developing breast cancer. Men can develop breast cancer but the disease is about 100 times more common among women than in men. This is probably because men have less of the female hormones, oestrogen and progesterone which can promote breast cancer growth (ACS, 2020).
Increasing age (Getting older): Several studies have reported that the risk of developing breast cancer increases with age. About 1 out of 8 invasive breast cancer are found among women younger than 45, while about 2 of 3 are found in older women (ACS, 2020).
History of breast cancer (Genetics): About 5-10% of breast cancer cases are thought to be hereditary, meaning that they result directly from gene defects called (mutation) inherited a parent. breast cancer risk is higher among women whose close blood relatives have breast cancer. Having one first degree relative (mother, sister or daughter) with breast cancer approximately doubles a woman’s risk. Having 2 first degree relatives increases her risk about 3-fold. Also, women with history of breast cancer in a father or brother also have increased risk of breast cancer (ACS, 2020).
Abnormal genes in the body (BRCA 1, BRCA2 genes): The most common cause of hereditary breast cancer is an inherited mutation in the BRCA1 and BRCA2 genes. In normal cells, these genes help prevent cancer by making proteins that keep the cells from growing abnormally. There is a high risk of developing breast cancer in one’s lifetime if a mutated copy is inherited. breast cancer linked to these mutations occurs more often in younger women and more often affect both breasts than cancer not linked to these mutations. breast cancer can also develop due to changes in other genes but cases are usually rare. Most 85% of women who get breast cancer do not have a family history of breast cancer (ACS, 2020).
Personal history of breast cancer: A woman with cancer in one breast has a 3 to 4 fold increased chance of developing a new cancer in the other breast or in another part of the same breast. This is different from recurrence (return) of the first cancer (ACS, 2020).
Race and ethnicity: Overall, white women are slightly more likely to get breast cancer than African- American women. African-American women, though, are more likely to die of breast cancer. However, in women under 45 years of age, breast cancer is more common in African women. Asian, Hispanic, and native-American women have a lower risk of developing and dying from breast cancer (ACS, 2020).
Height: Taller than average women have a slightly higher likelihood of developing breast cancer than shorter women. Experts are not sure why. Analysis of African breast cancer cases and controls studied in Ibadan showed an association with height (adjusted odds ratio 1.05, 95% confidence interval 1.01 to 1.08), a marker for nutrition in early life and with waist-hip ratio (adjusted odds ratio 2.67, 95% confidence interval 1.05 to 6.80) (ACS, 2020).
Dense breast tissue: Dense breast tissue means there is more gland tissue and less fatty tissue in a woman’s breast. Women with denser breast tissue have a risk of breast cancer that is 1.2 to 2 times that of women with average breast density of breast cancer. Dense breast tissue can also make MAMO less accurate. A number of factors can affect breast density: age, pregnancy, genetics, certain medications, menopausal status, hormone therapy etc. (ACS, 2020).
Benign lumps/tumours: Women with certain benign lump or tumour in breast have an increased risk of breast cancer. Some lumps conditions are more closely link to breast cancer than others (ACS, 2020).
Lobular carcinoma in situ: In this condition, cells that look like cancer cells are in the milk- making glands (lobules), but do not grow through the wall of the lobules and cannot spread to other parts of the body. It is not a true cancer or pre-cancer, but having LCIS increases a woman’s risk of getting cancer in either breast later (ACS, 2020).
Menstrual Periods: Women who have had more menstrual cycles because they started menstruating early before age 12 and on went through menopause later after age 55 have a slightly higher risk of breast cancer. This may be due to a longer lifetime exposure to the hormones oestrogen and progesterone (ACS, 2020).
Previous chest exposure to radiation: women who have children or young adults had radiation therapy to the chest area have significantly increased risk of developing breast cancer. The risk of developing breast cancer from chest radiation is highest if the radiation was given during adolescence, when breasts were still developing. Also, undergoing X-rays and CT scans may raise a woman’s risk of developing breast cancer slightly (ACS, 2020).
Diethylstilbestrol exposure: Exposure to DES, a drug given to pregnant which lowers the chances of miscarriage slightly increased the risk of breast cancer. Women whose mother took DES during pregnancy may also have a slightly higher risk of developing breast cancer (ACS, 2020).
Some modifiable breast cancer life-style related factors are;
Nulliparity/Late age at first pregnancy: Women who have not had children, or who had their first child after age 30, have a slightly higher risk of breast cancer. Being pregnant more than once and at early age reduces breast cancer risk. Having many pregnancies and becoming pregnant at young age reduce breast cancer risk. Pregnancy reduces a woman’s total number of lifetime menstrual cycles, which may be the reason for this effect. Still, the effect of pregnancy is different for different types of breast cancer. For a certain breast cancer type known as triple-negative, pregnancy seems to increase risk (ACS, 2020).
Birth control/Oral contraceptives: Women using OCPs have a slightly greater risk of breast cancer than women who have never used them. Risk seems to go back to normal over time once the pills are stopped. Women who stopped using the pill more than ten years ago do not seem to have any increased risk. It’s a good idea to talk to one’s doctor about the risks and benefits of birth control pills (ACS, 2020).
CONCLUSION AND RECOMMENDATION
This study highlights the need for the female undergraduate students in Delta State University who are young women between 15 and 45 years to get more of knowledge of breast cancer and management measures as it has been found to be deficient. It is apparent that there is a huge knowledge gap to be filled in terms of risk factors, symptoms, causes, treatment and early detection screenings. Young women particularly those in higher institutions should be knowledgeable about health issues such as breast cancer and early detection screening so that they can enjoy optimum health in future. Low disease knowledge coupled with wrong perceived causes and susceptibility has resulted in their poor screening behaviour, attitude, choice and preference of screenings. This is largely due to poor access to correct information about the causes and prevention of the disease and lack of National established Breast Cancer Care Centre. There is therefore an urgent need to provide health education to this group of people to provide health education in order to correct false and assumed notions and improve protective and early detection screening behaviours. There is a need to identify culturally appropriate methods to teach women how to perform BSE and enhance their self-efficacy in using this method since majority preferred it. Interventions to promote culturally sensitive public health programs designed to provide information and services that cut across different age groups, educational levels and cultures should also be developed and implemented.
It is necessary to enlighten women of this age group on breast cancer risk factors and management measures. Developing proper health practices should commence as early as possible and should lead to lifetime maintenance of good health (Ranasinghe, 2013). Informing youth about breast cancer is both a challenge and a key investment in the health of future generations of women (Boulos and Ghali, 2020).
From the findings obtained in the study, the following recommendations have been made:
Health education on breast cancer should be provided to students in tertiary institutions through formal teaching in the school and informally through campaigns and health programs among students.
There is a need for radio and television programmes dedicated to enlightening and educating people about breast cancer early detection screening methods, since it is the preferred information source on breast cancer.
Equip health education units in university health centres and government hospitals so that all information and educative programmes on breast cancer can be easily accessed by students and staff members of the school.
Health educators should continue to collaborate with the non-governmental health organisations to conduct more health programmes on breast cancer among female undergraduate students.
Improvement on the existing health facilities by the government as well as establishment of breast cancer cancer screening centres in all the states and local government areas.