Determinants of Breast Cancer Screening among Rural Women, Homa Bay County, and Western Kenya

International Journal of Research and Innovation in Social Science (IJRISS) |Volume VI, Issue VI, June 2022|ISSN 2454-6186 Determinants of Breast Cancer Screening among Rural Women, Homa Bay County, and Western Kenya Felix Blair Odhiambo1, 2*, John Paul Oyore2, BOM Agina2 1 The Catholic University of Eastern Africa, Department of Community Health and Development. P.O. Box 62157-00200. Nairobi, Kenya 2 Kenyatta University, School of Public Health, Department of Community Health and Epidemiology. PO BOX 43844-00100, Nairobi, Kenya *Corresponding author Abstract - Breast cancer is a serious disease and it is one of the major causes of morbidity and mortality in Kenya and the World as a whole. It can be controlled by early detection, and prompt treatment or management. This paper aimed to demonstrate the screening levels of breast cancer among women in Homa-Bay County and determine factors associated with breast cancer screening. This was a cross-sectional study, which was done in April 2019 in two purposively selected sub-counties in Homa Bay County, Western Kenya. A region, which had previously registered lower screening levels of cancer in national surveys. Data analysis was majorly descriptive showing proportions. A Chi-square test was used to check for the association of categorical variables with breast cancer screening. Results indicated that the majority of the respondents had not gone (87.35%) for screening compared to those who had gone for screening (12.65%). Factors that were found to be significantly associated with breast cancer included if the woman was smoking (Chi-Square p-value = 0.02, history of a family member diagnosed with breast cancer (Chi-Square p-value = 0.004), and having undergone X-ray at one point in life (Chi-Square p-value = 0.021). The study concluded that breast cancer screening is still very low in Homa- Bay County and factors such as smoking and having a family member who had been diagnosed with breast cancer are associated with breast cancer screening. We recommend an increased health promotion and education activities based on breast cancer screening so that the women can go for the available cost-effective screening methods such as Clinical Breast Examination in Homa Bay County. This can be done through increased campaigns for breast cancer screening and home visits to encourage breast cancer screening or selfbreast examination. Keywords: Breast cancer, screening, women, detection, and home campaigns. I. INTRODUCTION B reast cancer is one of the most common cancers worldwide [1]. Breast cancer is the leading cancer in women accounting for 24.2%of cancer cases in women and it is the leading cause of death of cancer deaths in women (15%) according to the global cancer report [1]. The incidence of new cancers is about 1.7 million representing about 12% of all new cancer cases and 24% of all cancers in women. Breast www.rsisinternational.org cancer is also the fifth most common cause of cancer deaths in women after lung cancer, liver cancer, colorectal cancer, and stomach cancer respectively [2]. Moreover, more deaths result from breast cancer in developing countries as compared to the developed countries despite higher incidences in the developed countries [3]. Regionally, in Eastern Africa, breast cancer incidence according to the global cancer statistics stands at 19.3 per 100000 women compared to 89.7 per 100000 women in Western Europe [1]. In Kenya, breast cancer is the third highest cause of morbidity and mortality with a prevalence of 34 per 100,000 people [4]. Breast cancer also accounts for 7% of deaths annually, according to [5].This is after infectious diseases and cardiovascular diseases [5]. This high prevalence and incidences rates of breast cancer need to be controlled. One method of breast cancer control is early breast cancer diagnosis through early screening especially in targeting risk populations [6]. Early screening of breast cancer leads to early treatment and is important in preventing deaths that breast cancer would cause [7]. In Kenya, the Ministry of Health proposes breast cancer screening in its National Strategy for the Prevention and Control of Non-Communicable Diseases 2015-2020 [4] . Breast cancers detected early during screening examinations are likely to be minor and still restricted to the breast, making them easier to treat [7]. Coincidentally, the greatest hindrance to early treatment of breast cancer patients is late screening [8] contributed to inadequate knowledge of Kenyans on breast cancer [9]. Other limitations to breast cancer screening include inadequate screening centers [5], and a lack of well-equipped health facilities for the public with the ability to handle cancer cases. By end of the year 2018, there were only five cancer radiation centers in the country, which are all in the capital city of Nairobi; the human capacity is also considerably low. Cognizant of the cancer threat in Kenya, intervention approaches such as awareness programs focusing on early diagnosis, advancement in medical facilities, and the rise of cancer campaign groups as well as the creation of a cancer Page 888 International Journal of Research and Innovation in Social Science (IJRISS) |Volume VI, Issue VI, June 2022|ISSN 2454-6186 research institute have been put forward [4]. In terms of screening, currently there exist a higher screening for breast cancer in developed countries at 78% but this is not the same for developing countries where screening is at 18% [7]. As a result of higher screening in developed countries, it has resulted in early treatment. However, many patients succumb to the disease in developing countries including Kenya due to low survival rates associated with late diagnosis and late-onset of treatment of breast cancer patients [1]. Moreover, there also exists a variation in screening uptake for breast cancer between urban and rural women in response to breast cancer screening services in Kenya [10]. Women in urban areas have a higher probability (90 % odds) of access to breast cancer screening compared to their rural counterparts in Kenya [10]. This inadequate knowledge of breast cancer and low breast cancer screening results in late cancer diagnosis and hence lots of death. In addition, the latest figures in Homa Bay County recorded lower screening levels of 7.8 % [11] against, the screening rate in Kenya at the same time, which was about 14 %. Furthermore, no cancer center exists in Homa Bay. These factors make most people die of breast cancer without knowing what was ailing them [11] having not been diagnosed with the disease. Late diagnosis of breast cancer makes it almost impossible for curative care for breast cancer patients. This paper presents the levels of screening and some of the behavioral factors that are associated with the breast cancer screening practice in Homa bay County. II. METHODOLOGY This was a cross-sectional descriptive study. Structured questionnaires were distributed to 320 women participants in two purposively selected sub-counties (regions) in Homa Bay County, Kenya. The 320 women were then drawn systemically from the selected household that consented to take part in the study. The systematic sampling procedure with a sample frame of households was provided by the local authority. Data analysis was descriptive while the association of factors was determined by using the Chi-square test of the hypothesis. Factors with p-values less than 0.05 were considered to be significantly associated with breast cancer screening. Before the study was undertaken, the reasons and purposes of the study were clearly explained to the participants. Ethical approval for the study was obtained from Kenyatta University Ethical Review Committee NO. PKU/901/1961. III. RESULTS Sociodemographic characteristics of the respondents Table one below explains the characteristics of the of participants. sociodemographic Table 1. Socio Demographic Characteristics Sub county n Ndhiwa N=162 Frequency Percent 95% CI <= 30.00 32 19.8 13.6 25.9 31.00 - 40.00 39 24.1 17.3 30.9 41.00 - 50.00 46 28.4 21.6 35.8 51.00 - 60.00 24 14.8 9.9 20.4 61.00 - 70.00 16 9.9 5.0 14.2 71.00 - 80.00 5 3.1 .6 6.2 <= 30.00 30 19.1 13.4 25.53 31.00 - 40.00 45 28.7 22.3 36.3 41.00 - 50.00 28 17.8 12.1 24.2 51.00 - 60.00 26 16.6 10.8 22.3 61.00 - 70.00 21 13.4 8.3 18.5 71.00 - 80.00 7 4.5 1.3 7.6 Non formal 13 8.0 3.7 12.3 Primary 51 31.3 23.9 38.7 Secondary 53 32.5 25.8 39.9 Tertiary Education 46 28.2 21.5 35.6 Non formal 16 10.1 5.7 15.2 Primary 90 57.0 48.7 64.6 Lower Age (Years) Kasipul Ndhiwa N=157 N=163 Level of education Kasipul www.rsisinternational.org Upper N = 158 Page 889 International Journal of Research and Innovation in Social Science (IJRISS) |Volume VI, Issue VI, June 2022|ISSN 2454-6186 Religious affiliation Ndhiwa Kasipul Marital status Ndhiwa Kasipul Polygamous marriage Ndhiwa Kasipul Main occupation Ndhiwa Kasipul Parity Ndhiwa www.rsisinternational.org Secondary 43 27.2 20.3 34.8 Tertiary Education 9 5.7 2.5 10.1 Catholics 30 18.4 12.3 24.5 SDAs 69 42.3 34.4 50.3 Protestants 57 35.0 27.6 41.7 Other 6 3.7 1.2 6.7 Muslim 1 .6 .0 1.8 Catholics 46 29.1 22.8 36.1 SDAs 50 31.6 24.1 39.2 Protestants 42 26.6 19.6 34.2 Other 20 12.7 8.2 17.7 Married 110 74.8 66.7 81.6 Divorced 7 4.8 1.4 8.2 Single 7 4.8 1.4 8.2 Separated 1 .7 .0 2.0 Widowed 22 15.0 9.5 21.1 Married 83 62.9 54.5 71.2 Divorced 10 7.6 3.8 12.1 Single 5 3.8 .8 7.6 Separated 2 1.5 .0 3.8 Widowed 32 24.2 15.9 31.8 Yes 35 23.8 17.0 30.6 No 112 76.2 69.4 83.0 N=132 Yes 47 35.6 27.3 43.9 No 85 64.4 56.1 72.7 N=147 Farming (Small scale) 53 36.1 28.6 44.2 Business 23 15.6 9.5 21.8 Teacher 46 31.3 23.8 38.8 House wife 21 14.3 8.8 19.7 Others 4 2.7 .0 5.4 Farming (Small scale) 84 63.6 55.3 71.2 Business 19 14.4 9.1 20.5 Teacher 4 3.0 .8 6.1 House wife 14 10.6 6.1 15.9 Others 11 8.3 4.5 12.9 1 18 12.2 7.5 17.7 2 29 19.7 13.6 26.5 3 29 19.7 13.6 26.5 N=163 N=158 N=147 N=132 N=147 N=132 N=147 Page 890 International Journal of Research and Innovation in Social Science (IJRISS) |Volume VI, Issue VI, June 2022|ISSN 2454-6186 Kasipul N=132 >3 68 46.3 38.1 54.4 5 3 2.0 .0 4.8 1 12 9.1 4.5 14.4 2 15 11.4 6.1 17.4 3 15 11.4 6.8 17.4 >3 87 65.9 57.6 73.5 5 3 2.3 .0 5.3 Behavioral characteristics Table 2 summary of behavioral characteristics of the women 95% CI Alcohol Sub county N Ndhiwa 158 Kasipul Tobacco Ndhiwa Kasipul Having a Family member diagnosed with cancer Use of hormonal pills Sexually active % Lower Upper Yes 13 8.2 3.8 12.7 No 145 91.8 87.3 96.2 Yes 8 5.0 1.9 8.8 No 151 95.0 91.2 98.1 159 149 150 Yes 1 .7 .0 2.0 No 148 99.3 98.0 100.0 Yes 7 4.7 1.3 8.0 No 143 95.3 92.0 98.7 Ndhiwa N=158 yes 37 23.4 17.1 30.4 No 121 76.6 69.6 82.9 Kasipul N=153 yes 19 12.4 7.2 17.6 No 134 87.6 82.4 92.8 Ndhiwa N=161 yes 72 44.7 37.3 52.2 No 89 55.3 47.8 62.7 Kasipul N=151 yes 57 37.7 29.8 45.7 No 94 62.3 54.3 70.2 Yes 122 79.2 72.7 85.7 No 32 20.8 14.3 27.3 Yes 103 69.6 62.8 77.0 No 44 29.7 22.3 36.5 Ndhiwa Kasipul Have undergone X ray Frequency Ndhiwa Kasipul N=154 N=148 N=160 154 21 1 .7 .0 2.0 yes 55 34.4 27.5 42.5 No 105 65.6 57.5 72.5 yes 45 29.2 22.1 36.4 No 109 70.8 63.6 77.9 The table above summarizes the behavioral characteristics of the respondents www.rsisinternational.org Page 891 International Journal of Research and Innovation in Social Science (IJRISS) |Volume VI, Issue VI, June 2022|ISSN 2454-6186 Fig 1. Uptake of screening of breast cancer The respondents were also asked reasons why they do not go for screening in both the sub-counties, in Kasipul, 96.8 % said it is a dangerous exercise while another 93.6% said screening is not profitable to them, 86.6% feared cancer and hence would not want to be tested for it. It is also evident that lack of awareness was the least reason for not going for the screening. Only 59.2% and 42% in Ndhiwa and Kasipul respectively said they were not aware. Although this is still a large proportion of the respondents. IV. FACTORS ASSOCIATED WITH BREAST CANCER SCREENING Figure one above gives the level of breast cancer screening in the two sub-counties of Homabay. The level of breast cancer screening in the two sub-counties were 12.3% and 13% respectively for Ndhiwa and Kasipul. They had almost similar levels of breast cancer screening uptake. It shows lower screening levels of breast cancer in Homa Bay County. The figure above indicates the level of screening of breast cancer in Homa Bay County. Fig 2. Uptake of different screening methods The table below describes the analysis to find out the factors associated with breast cancer screening among the women in Homabay County in Kenya. Using a Chi-square test of hypothesis, smoking cigarettes was found to be associated with breast cancer screening (Chisquare =12.70, P-value = 0.02). Another factor that showed significant association was having a family member who has been diagnosed with cancer before (Chi-square =9.623, Pvalue = 0.004). Having experienced a form of treatment involving x-ray also was associated with going for breast cancer screening (Chi-square =5.31, P-value = 0.021. The rest of the factors did not show any significant statistical association. Table 3. Factors Associated with Breast Cancer Screening Screening for Breast Cancer Yes Being a Smoker The three major screening methods of breast cancer were looked at to see which among them is the most attended method is by the women of Homabay County. As shown on Fig 2 above, most of the women have gone for the clinical breast cancer examination (CBE) for both Ndhiwa (35.1%) and Kasipul at 38.2% respectively. Polygamy Alcohol intake No X2 value P value 12.70 0.02 0.378 0.344(ex act) 3.696 0.158 1.485 0.223 9.623 0.004 1.485 0.223 2.714 0.438 Yes 2 6 No 24 265 Yes 8 84 No 19 201 Yes 4 15 No 24 268 Yes 11 116 No 24 159 Yes 13 22 No 43 231 Yes 11 24 No 116 159 Yes 23 13 Fig 3. Reasons for not screening for cancer. Use of hormonal pills Having a Family member diagnosed with cancer Use of family planning pills Sexual Activity www.rsisinternational.org Page 892 International Journal of Research and Innovation in Social Science (IJRISS) |Volume VI, Issue VI, June 2022|ISSN 2454-6186 X ray Experience No of Children No 199 Yes 18 19 No 82 193 6 30 31 239 2 and below More than 2 5.31 0.021 services [18]. In their research in Uganda demonstrated that the extent of literacy and position of an individual at work had an influence on screening for breast cancer. This is backed by a research that found that the hectic schedule of employed women to be one of the variables connected to breast cancer screening [12] 0.803 0.412 VI. CONCLUSION AND RECOMMENDATIONS 63 V. DISCUSSION The results indicate low breast cancer screening among rural women in Homa Bay County in the sub-counties of Ndhiwa and Kabondo where the research was done at 12.3% and 13 % respectively. From the results, the screening method that has been experienced by the residents of these two sub-counties in the Clinical Breast Examination (CBE) at 35.1% and 38.2% in Ndhiwa and Kabondo respectively. CBE was higher compared to Self-breast examination (SBE) and mammogram in both sub-counties. Most people are likely to go for CBE because of the confidence they have in the health practitioner to assess their condition compared to their test. As for mammography, the high cost associated with it could have led to it being shunned by the women. The reasons for low breast cancer screening could be due to the perceived high cost of screening as 71.3% of the respondents in Ndhiwa while 82% in Kasipul Sub County indicated that high cost is one of the reasons which can hinder them from undertaking breast cancer screening. Other reasons included such reasons as the perception that the screening process is dangerous (77.7 % in Ndhiwa and 96.8%) in Kasipul respectively. A study by [12] and [13] found attitudinal factors as some of the reasons why women don't go for breast cancer screening corroborate these findings. Figure three above shows other reasons why there could be reduced screening levels of breast cancer among rural women. Even though binary, the analysis did not reveal a statistical significance with the chi-square test. These findings corroborate a finding by Patel et al (2014) on the reasons for low breast cancer screening. Other factors did not show any significant statistical association with breast cancer screening. This paper concludes that being a smoker, having a family members who has been diagnosed with cancer and having been done for a X ray were significantly associated with the breast cancer screening among women in Homa Bay county. Meaning those who had family members diagnosed with a cancer were more likely to go for breast cancer screening. In addition those who smoke and those have gone for X ray previously were more likely to for breast cancer screening. Hindrances to breast cancer screening included the perceived high cost of most screening methods for breast cancer, the perception that screening is dangerous, and fear of being diagnosed with cancer. This paper suggests a need for increased health promotion and education activities based on breast cancer screening so that the women can go for the available cost-effective screening methods such as Clinical Breast Examination. Conflict of interest. There is no conflict of interest that pertains to the publication of this paper ACKNOWLEDGEMENTS I would like to thank my research team that assisted data collection of the study and the county government of Homa Bay for allowing this research to take place. 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