Factors Influencing Breast Cancer Screening Among Women of Reproductive Age in Nandom Municipality, Ghana | BMC Women’s Health

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This current study found that a majority (51.9%) of respondents had already been screened for breast cancer. The study also reported that only 2.5% of women had ever examined their breasts using a mammogram. Low rates of use of mammography for breast cancer screening have been reported in similar studies conducted in Ghana [17,18,19,20]. Mammography is often used as a diagnostic examination rather than for screening due to lack of routine screening mammography services and high cost in Ghana [17]. Adding mammography services to the Ghana National Health Insurance Scheme (NHIS) would be beneficial and catalyze breast cancer screening.

Furthermore, the current study found that only 14.4% of respondents had undergone EPC. This result is very low because CBE is less expensive and effective in detecting lumps and other breast abnormalities. Similarly, other studies in Ghana have reported low use of CBE [17, 20, 21]. Additionally, an intervention study in Kenya indicated that the rate of CBE use among women increased by 38.0% when the intervention group received community health education delivered by community health workers. [22]. This indicates the need to sensitize communities about EPC to improve the low rate of participation in early detection and treatment of cancer. The low use of CBE in Ghana is of concern as the breast cancer survival rate is 39% [23]. The lack of a national cancer registry could also mean that cases are underreported. In addition, 33.7% of respondents to this study practiced BSE. A slightly higher percentage (42.6%) of trainee health professionals in Ghana experiencing BSE was also reported by Osei-Afriyie et al. (2021) [20]. Another study of breast cancer patients in Ghana found that respondents rarely practiced BSE before their diagnosis. [24].

The current study found that respondents who had a tertiary level of education were less likely to be screened for breast cancer. However, a similar study conducted in Accra and Sunyani, Ghana showed that higher level of education was significantly associated with uptake of breast cancer screening. [17]. The finding of the current study could mean that women who have reached higher education could be overwhelmed by work schedules and not be able to attend or make an appointment for breast cancer screening. In addition, a study conducted in Ghana showed that respondents who had ever attended school were more likely to undergo breast cancer screening. [19]. In addition, a study of women in Iran showed that educational level was significantly associated with BSE [25].

Factors that may influence the uptake of breast cancer screening investigated in this study include HBM constructs (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and self-efficacy). Regarding perceived susceptibility, the current study found that the majority (65.4%) of respondents believed themselves to be susceptible to breast cancer. In contrast, a study in Ghana of female clinicians from Ga West and South found that 55.0% of respondents had low perceived susceptibility to breast cancer. [26].

Regarding the perceived seriousness of breast cancer, the current study found that the majority of respondents (92.6%) thought it would be dangerous to have breast cancer. This is similar to a cross-sectional study of college students in Iran, which reported high perceived severity of breast cancer [27]. According to the current study, the belief that breast cancer could lead to death, removal of the breast and the danger of breast cancer accounted for the high perceived severity recorded. This implies that respondents would be more likely to undergo breast cancer screening to prevent the severity of breast cancer. Health interventions should therefore increase the severity of breast cancer in health promotion interventions so that people can get screened for early detection and treatment.

Additionally, 96.3% of respondents to the current study believed that breast cancer screening was beneficial. A comparable study in Ghana reported similar results [26]. In contrast, a study in Ghana’s Accra metropolitan area of ​​nurses and midwives found that 67.0% perceived breast cancer screening as not beneficial. [21].

Approximately 56.8% of respondents to this study believed that there are barriers that prevent them from undertaking breast cancer screening. A similar study in Ghana of female clinicians found that 51.0% perceived high barriers to breast cancer screening. [26]. Some of the barriers mentioned by respondents in this study include: fear of finding out that something is wrong (49.8%) and not knowing where to get tested (40.9%). Also, 43.2% and 35.0% believe that screening is respectively painful and costly. These barriers must be minimized or removed to encourage women to undergo breast cancer screening. For example, breast cancer screening could be covered by the NHIS so that women do not have to pay extra money to get screened if they go to the health facility.

When it comes to perceived self-efficacy, 93.4% of respondents in the current study were confident that they could undertake breast cancer screening. This implies that they believed they could overcome existing barriers and get screened for breast cancer. Similar results were found in a cross-sectional study of college students in Iran, which showed that perceived self-efficacy was high among respondents. [27]. This indicates that increasing women’s confidence in breast cancer screening is therefore recommended to improve service utilization. Furthermore, a study of clinicians in the Ga West and South districts of Ghana showed that about 54% of respondents had low self-efficacy regarding breast cancer screening. [26]. This reaffirms the need to increase women’s confidence so that they can easily undertake breast cancer screening.

The association between HBM constructs and use of breast cancer screening showed that respondents who perceived a high susceptibility to breast cancer were more likely to be screened for breast cancer. Similarly, a study in Turkey of women aged 40 and over showed that perceived susceptibility was a strong predictor of breast cancer screening. [28]. Furthermore, a study of undergraduate students in the Volta region of Ghana showed that those who did not think they were susceptible to breast cancer were less likely to get screened. [20]. It can be inferred from the current finding that designing interventions to target the perceived susceptibility of respondents is essential as this would clarify the risk factors for breast cancer.

Additionally, the current study found that respondents who perceived high breast cancer severity were more likely to be screened for the disease. Perceived breast cancer severity was also found to be a strong predictor of breast cancer screening among older women in Turkey. [28]. A similar study among college students in northwestern Iran showed that high perceived severity was a predictor of breast cancer screening behavior. [27]. The seriousness of breast cancer to the individual, family and society as a whole should be placed at the center of health promotion interventions so that women are compelled to get screened.

Additionally, respondents who perceived high barriers to breast cancer screening were less likely to undergo breast cancer screening. Accordingly, a similar study conducted in Iran showed that perceived barriers were significantly associated with breast cancer screening. [25]. A study in Turkey found that perceived barriers were strongly associated with breast cancer screening [28]. Furthermore, a similar study with clinicians in Ghana showed that perceived barriers were significantly associated with uptake of breast cancer screening. [26]. In the present study, it can be said that respondents who perceive barriers might have difficulty getting screened for breast cancer. Health promotion interventions to improve breast cancer screening should focus on reducing barriers to screening.

However, the current results must be interpreted taking into account certain limitations. Convenience sampling used at the last stage of multistage sampling is a non-probability sampling method and may limit the generalizability of the results of this research. The cross-sectional nature of the study design limits the ability to attribute a causal relationship between factors associated with breast cancer screening and screening uptake among participants. Additionally, the study used a questionnaire to elicit responses on a sensitive topic (breast cancer screening) which has the potential to introduce social desirability bias and there was no way to validate what respondents said. However, ensuring the anonymity and confidentiality of responses should have minimized possible limitations. Cultural factors could also shape breast cancer screening behavior in the Ghanaian context, but these factors are not taken into account in the HBM. Despite these limitations, this study provides insight into the factors influencing breast cancer screening among women of reproductive age in Nandom Municipality, Ghana using the HBM.

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