Outreach programmes undertaken by Breast Care International (BCI), a Ghanaian NGO dedicated to raising breast cancer awareness has improved knowledge, attitudes and practices toward the disease among women from rural communities.
A cross-sectional survey conducted by experts on ?Evaluation of the Impact of a Breast Cancer Awareness Programme in Rural Ghana? published by the International Journal of Cancer (IJC) said BCI?s programmes can be successful even at the grassroots involving illiterates.
However, the survey said further research is warranted to provide stronger evidence that the programme improves breast cancer early detection.
It said community awareness is crucial to early detection of breast cancer in Low and Middle Income Countries (LMICs) and in Ghana 60 per cent of the cases are detected at late stages.
Breast cancer is the most common malignancy and first cause of cancer mortality in women worldwide.
Its worldwide prevalence is still on the rise and currently breast cancer is considered to be an increasing public health problem among LMICs.
Dr Beatrice Wiafe-Addai, a Breast Oncologic Surgeon is the Executive Director of BCI established in Kumasi in October 2002.
The NGO is a subsidiary of the Peace and Love Hospitals, which provide breast cancer diagnosis and treatment in Kumasi and Accra.
Dr Wiafe-Addai is also the Chief Executive Officer (CEO) of the two health facilities.
The BCI is composed of a team of a breast oncologic surgeon, 30 specialised nurses and supporting staff.
Its programme is based on an hour lecture on breast cancer facilitated by the surgeon followed by free Clinical Breast Examinations (CBE) provided by the surgeon and the nurses.
The women found to have breast abnormalities are referred to the hospitals.
During the public awareness, participants are informed about the burden of the disease, common breast cancer symptoms and risk factors, benefits of early detection and then trained on how to perform Breast Self-Examination (BSE).
Pictures and other materials are shown and breast cancer survivors participate in peer education. The BCI team travels to the 10 regions to conduct outreach programmes opened to everybody after initial contact and approval of the local authorities.
The BCI programme aims to reach the whole adult female population of the communities. Thus, involvement of community leaders and other community members in the organisation of the programme is crucial. The intervention is conducted in the local languages.
After the initial programme, BCI organises annual follow-ups where one more time a reminder lecture on breast cancer with room for questions and free CBE are provided to the participants from the communities, with the aim again to get the participation of as many women from the communities as possible.
BCI collaborates with other local organisations devoted to increase breast cancer awareness in the country, such as Reach for Recovery, HopeXChange, Sister Support Network or Mammocare to coordinate efforts.
In 2009 they jointly launched the Ghana Breast Cancer Alliance with the support of international organisations as Susan G Komen for the CureVR and the Breast Health Global Initiative.
The major effect of the BCI awareness programme, is a better recognition that a painless breast lump is an important symptom warranting further evaluation, and may be key for improving early breast cancer detection in communities where screening is not performed.
However, the BCI programme was not successful in improving knowledge of risk factors, because the scope of the study was limited, only covering age and positive family history of breast cancer and not addressing obesity, alcohol intake, early menarche, nulliparity or lack of breast feeding.
It did not have any impact on reducing the belief that breast cancer can be caused by evil spirits, but overall the programme had a good impact on attitudes and practices toward breast cancer. Women from the communities showed positive medical-help-seeking behaviour by choosing visiting the doctor as the best approach to care.
Distinctly, herbal treatment is one of the major reasons for delayed presentation of women newly diagnosed with breast cancer and breast cancer patients in a teaching hospital in Accra.
The main impact of the programme was on practice of BSE and the main reason for not practicing BSE was considering not having any breast problem.
Following the programme, the knowledge on breast cancer was better in particular for improving early detection such as recognition of breast lumps.
Some misunderstanding on risk factors may be considered less important as long as women know that finding a persistent breast lump on BSE requires medical evaluation.
A common misconception is that women who lack a family history of breast cancer are
not at risk for the disease.
In fact, the majority of women diagnosed with breast cancer do not have a family history or strong risk profile, which is why screening needs to be, directed at the general population of women above a specified age cut off.
The programme did not have impact on changing some beliefs that may delay presentation but on attitudes and practices toward breast cancer, especially in motivating women to practice BSE.
Even if BSE has not been shown to reduce breast cancer mortality, this simple and cheap technique jointly with CBE have never been tested in LMICs where mammography procedures have limited application and mean tumor sizes at presentation are above five centimetres and might yet prove to be valuable.
The study suggested that improvement in the BCI programme is to devote more efforts to change beliefs related to breast cancer, which can encourage women to seek early treatment.
In addition, involving men in the programme could help and reduce women?s fear of being rejected by their husbands if they get breast cancer.
Training and involving of community health workers in the BCI awareness programme will reinforce the sustainability of the improved KAP and the necessary link between the knowledge gained and the seeking early medical help.
Education is clearly critical, but can be out of the scope of BCI, Ghana Health Service, Ministry of Health and other policy makers should focus on such interventions.
In addition, collaborations between oncology services and civil society organisations must be enhanced.
Funding is needed to link this increased awareness to appropriate diagnosis, care and follow-up.
Surgery still represents the main form of treatment for breast cancer in the country and as in other African countries some cultural beliefs and mysticisms surround the disease.
A total of 232 women were interviewed in June 2011 in the Ashanti Region; of these 131 participants were from a community that received the BCI programme in August 2010 (intervention group) and 101 from another community that received the programme post-survey (referent group).
The intervention community that received the BCI programme for the first time in August 2010 was Nkwantakese in the Afigya-Kwabre District (1,828 inhabitants).
The referent community was Foase Kokoben in the Atwima Kwamwoma District (5,023 inhabitants, according to a 2009 house-by-house census).
These communities were invited to participate in the study after contacting and receiving approval from local authorities.
Ethical clearance was issued by the Peace and Love Hospital Ethics Committee and written informed consent was obtained from study participants before enrollment.
For illiterate women, the information was given orally by reading the informed consent form and the consent was obtained by ink fingerprint. GNA