Barriers to Mammography Screening in Nigeria: A Survey of Two Communities With Different Access to Screening Facilities

Abstract

Purpose Breast cancer outcomes are poor in most low- and middle-income countries. This is a result, in part, of delayed presentation. Critical to improving this gloomy picture is the promotion of breast cancer screening programs; however, designing a formidable screening program requires obtaining necessary background data. This survey evaluates breast cancer screening practices and barriers in two Nigerian communities with different geographic access to screening facilities. Methods We administered a 35-item questionnaire to women age 40 years and older—1,169 participants (52.6%) in the Ife Central Local Government, where mammography services are offered, and 1,053 (47.4%) in the Iwo Local Government, where there are no mammography units. Information on breast cancer screening practices and barriers to mammography screening were compared between the two communities. Results Most women had heard of breast cancer (Ife, 94%; Iwo, 97%), but few have had any form of breast cancer screening recommended to them—37.7% of Ife respondents and 36.6% of Iwo respondents. Few women were aware of mammography (Ife, 11.8%; Iwo, 11.4%), whereas mammography uptake was 2.8% Ife respondents and 1.8% in Iwo respondents, despite the latter offering mammography services. Awareness and practice of mammography were not statistically different between the two communities ( P = .74 and P = .1 for Ife and Iwo, respectively). Lack of awareness was the most common reason cited for not undergoing mammography in both communities. Cost was also identified as a barrier, as only 20% of respondents could afford mammography. Despite being offered at little or no cost, uptake of clinical breast examination (CBE) was poor in both communities—27.4% in Iwo and 19.7% in Ife; however, the majority were willing to participate in a routine CBE-based breast cancer screening program. Conclusion Access without awareness and community mobilization does not guarantee use of breast cancer screening services. Given the above findings, a comprehensive breast health program that incorporates awareness creation, routine CBE-based screening, and selective mammography is currently underway in a selected Nigerian community. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the author

Contemporary management of breast cancer in Nigeria: Insights from an institutional database

“…20 Only 2.3% of women reported ever having had a mammogram. 21 As population-based screening is impractical in most resourcelimited settings, interventions should be aimed toward timely presentation and earlier diagnosis of clinically apparent disease. 22 Screening directed at high-risk populations is one potential strategy.…”

“…In a recent survey of over a thousand women in a Nigerian community, only about 20% of the women had ever had a clinical breast examination, the majority not in the last 1 year 20 . Only 2.3% of women reported ever having had a mammogram 21 …”

Association of Sociodemographic Factors, Breast Cancer Fear, and Perceived Self-Efficacy With Breast Cancer Screening Behaviors Among Middle-Aged Nigerian Women

“… 13 Also, it has been recommended that women start routine screening at 40 to 44 years of age. 14 However, previous studies indicated that BCS uptake is deficient in Nigerian women. 15 , 16 For instance, a study 17 reported that only 3% of women who qualified for annual screening had undergone mammographic screening, while another study reported that only 27.4% participated in CBE.…”

“… 15 , 16 For instance, a study 17 reported that only 3% of women who qualified for annual screening had undergone mammographic screening, while another study reported that only 27.4% participated in CBE. 14 Despite the benefits of BCS, many factors influence its uptake among Nigerian women. Such factors include women’s personal or demographic characteristics, fear of screening outcome, lack of capacity (self-efficacy), ignorance, healthcare-related factors, poverty, and cost of screening.…”

“…Such factors include women’s personal or demographic characteristics, fear of screening outcome, lack of capacity (self-efficacy), ignorance, healthcare-related factors, poverty, and cost of screening. 9 , 12 - 18 These factors could be linked to avoidance of BCS and associated adverse outcomes in Nigerian women. 5 - 8 However, the present study specifically focused on the associations among BC fear, perceived self-efficacy, women’s demographic characteristics, and BCS behaviors.…”