CHAPTER ONE

Breast cancer remains a critical public health challenge worldwide, particularly as it is the

leading cause of cancer-related mortality among women. Conceptually, according to Theeb et al.

(2023), breast cancer is a malignant condition originating in the breast tissues, characterized by

the uncontrolled growth of abnormal cells. This condition is often classified based on molecular

subtypes, which guide treatment strategies and prognosis. Meshkani et al. (2022) added that

breast cancer represents a significant global health challenge, accounting for substantial

morbidity and mortality, particularly in developing regions where healthcare resources are

limited. Early detection through regular screening is a cornerstone for improving outcomes, yet

the uptake of screening methods such as mammography and clinical breast examination remains

suboptimal globally(Meshkani et al. 2022).

Similarly, Theeb et al. (2023) opined that knowledge about breast cancer and its screening

options significantly influences health-seeking behavior, emphasizing the necessity for

comprehensive education and awareness campaigns. Knowledge about breast cancer refers to

individuals’ understanding of its risk factors, symptoms, and preventive measures, as well as the

methods of early detection (Adetona, Osungbade, Akinyemi, & Obembe, 2021). Heena et al.

(2019) claimed that comprehensive awareness of breast cancer screening methods—including

mammography, clinical breast examinations (CBE), and self-breast examinations (SBE)—is

critical for reducing mortality rates. Irani et al. (2021) further elaborated that informed

populations are more likely to adopt preventive behaviors, enhancing early detection and

improving treatment outcomes. However, despite increased efforts, significant knowledge gaps

and negative attitude remain in many communities.

Additionally, attitude towards breast cancer screen encompasses the beliefs, perceptions, and

predispositions that women hold towards breast cancer and its screening practices. Positive

attitudes, as noted by Madhu et al. (2021), are instrumental in promoting proactive health-

seeking behaviors. However, cultural norms, fear, stigma, and misconceptions often shape

negative attitudes, deterring women from seeking timely screenings in Nigeria. Onwuchekwa et

al. (2021) highlighted that addressing these attitudinal barriers through culturally sensitive health

communication is essential for improving participation in screening programs.

The interplay between knowledge and attitude significantly influences breast cancer screening

behaviors. Okomo et al. (2019) observed that women who possess adequate knowledge but hold

negative attitudes are less likely to engage in screening activities. Conversely, Adetona et al.

(2021) emphasized that even limited knowledge, when paired with positive attitudes, can lead to

better health outcomes. This dynamic highlights the need for integrated interventions that

simultaneously enhance knowledge and foster supportive attitudes.

In Nigeria, breast cancer poses a substantial public health burden, with late-stage diagnoses

being alarmingly common (Adesokan et al., 2021). Socioeconomic disparities, cultural beliefs,

and limited access to healthcare services exacerbate the challenges of early detection and

effective management. Ogunmodede et al. (2022) observed that educational interventions

tailored to address specific community needs have the potential to bridge these gaps, fostering

both knowledge and positive attitudes toward screening. However, the success of such programs

relies heavily on the active involvement of healthcare providers and the availability of screening

facilities. Moreover, antenatal clinics are invaluable platform for delivering breast cancer

education to expectant mothers. Bamidele et al. (2024) suggested that integrating breast health

awareness into routine antenatal care can significantly enhance knowledge and reshape attitudes
among pregnant women. Based on the aforementioned, this study seeks to evaluate the levels of

knowledge and attitudes toward breast cancer screening among mothers attending antenatal

clinics at LASUTH.

1.2 Statement of the Problem

Breast cancer represents a significant health challenge for women globally and is one of the

leading causes of death among women in Nigeria(George et al. 2019). According to WHO

(2020), The rate of breast cancer in Nigeria is estimated at 26 per 100,000 women annually, with

a mortality rate of approximately 13 per 100,000 women, making it a critical public health

concern. Sadly, irrespective of advancements in medical treatment, the disease’s impact is

heightened by the lack of early detection, which plays a pivotal role in reducing associated

mortality and morbidity (Odedina et al. 2019). Many mothers, including those attending

antenatal clinics, exhibit inadequate awareness and unfavorable attitudes toward breast cancer

screening. The lack of awareness is linked to the high incidence of late diagnosis and advanced

disease stages at presentation.

Ojewale et al. (2023), claimed that cultural barriers, widespread misinformation, and limited

access to accurate information have been identified as critical contributors to low screening rates

in the country. Evidence from prior research indicates that many Nigerian women harbor

significant knowledge deficits and hold negative perceptions regarding breast cancer screening

(Odedina et al., 2019; Ogunmodede et al., 2022). Compounding these challenges are

infrastructural inadequacies, a shortage of trained healthcare professionals, and limited access to

diagnostic services (Adetona et al., 2021). These factors collectively hinder the early detection of

breast cancer, thereby perpetuating its high mortality rate. Heena et al., (2019), claimed that the

potential of leveraging antenatal care settings for effective health interventions. However, such
approaches remain underexplored in Nigeria, where healthcare delivery is often constrained by

socio-cultural and systemic challenges.

Breast cancer remains one of the leading causes of cancer-related morbidity and mortality among

women worldwide. Early detection through regular screening methods such as breast self-

examination (BSE), clinical breast examination (CBE), and mammography significantly

improves treatment outcomes and survival rates. However, in many developing countries,

including Nigeria, the uptake of breast cancer screening services remains low due to various

factors such as inadequate knowledge, cultural beliefs, fear, and limited healthcare access.

Expectant mothers attending antenatal clinics represent a crucial population for health

interventions, as they frequently engage with healthcare providers and may influence broader

community health behaviors. However, there is limited research on their level of awareness,

perception, and willingness to participate in breast cancer screening programs, particularly in

tertiary healthcare facilities like the Lagos State University Teaching Hospital (LASUTH).

Understanding the knowledge and attitude of this group toward breast cancer screening is

essential for designing effective educational interventions and policies that promote early

detection. This study seeks to assess the level of knowledge, attitude, and associated factors

influencing breast cancer screening uptake among mothers attending antenatal clinics in

LASUTH. Identifying these gaps can help inform targeted strategies to enhance screening rates

and reduce the burden of late-stage breast cancer diagnosis.

1.3 Objectives of the Study

The broad objective of the study is to assess the knowledge and attitude towards breast cancer

screening among mothers attending antenatal clinics in LASUTH, while the specific aims of the

study includes:

1. To assess the knowledge of breast cancer screening among mothers attending antenatal clinics

in LASUTH.

2. To assess the attitude towards breast cancer screening among mothers attending antenatal

clinics in LASUTH.

3. To explore perceived factors influencing the attitude towards the uptake of breast cancer

screening among mothers attending antenatal clinics in LASUTH.

1.4 Research Questions

The following questions drafted in line with the study objectives, will guide the study;

1. What is the level of knowledge of breast cancer screening among mothers attending

antenatal clinics in LASUTH?

2. What is the attitude towards breast cancer screening among mothers attending antenatal

clinics in LASUTH?

3. What are the perceived factors influencing the attitude towards the uptake of breast cancer

screening among mothers attending antenatal clinics in LASUTH?

1.5 Hypotheses
Ho₁: There is no significant relationship between the knowledge and attitude of mothers on

breast cancer screening among mothers attending antenatal clinics in LASUTH.

Ho₂: There is no significant association between mothers’ level of education and their

knowledge of breast cancer screening.

1.6 Significance of the Study

The findings will contribute to the growing body of evidence on breast cancer prevention in

Nigeria, guiding health practitioners, policymakers, and researchers in designing targeted

interventions.

To mothers: The study will benefit mothers by identifying gaps in their knowledge and

misconceptions about breast cancer screening. This will help in developing educational programs

tailored to improve their awareness and encourage the adoption of early detection practices.

To healthcare providers: Healthcare professionals at LASUTH and similar institutions will gain a

better understanding of the existing barriers to breast cancer screening among antenatal clients.

This will enable them to implement more effective health education strategies within the

antenatal care framework.

To researchers: This study will fill a critical knowledge gap by providing data on the attitudes

and practices of Nigerian mothers concerning breast cancer screening. It will also serve as a

reference for future research in similar contexts.

1.7 Delimitation of the Study

This study will be delimited to mothers attending antenatal clinics at Lagos State University

Teaching Hospital (LASUTH). It will focus specifically on assessing their knowledge and

attitudes toward breast cancer screening.

1.8 Operational Definition of Terms

Mothers: Women who are currently pregnant or have given birth to a child, attending antenatal

clinics at the Lagos State University Teaching Hospital (LASUTH) during the study period.

Breast Cancer: A malignant tumor that develops in the cells of the breast, which can be detected

early through regular screening practices such as clinical breast exams, mammography, and self-

breast examination.

Breast Cancer Screening: investigative procedures such as self-breast examinations, clinical

breast examinations, and mammography aimed at detecting breast cancer early, before symptoms

appear.

Knowledge: Awareness and understanding that mothers possess about breast cancer screening,

including its importance, methods, and timing.

Attitudes: Perceptions, beliefs, and feelings of mothers toward breast cancer screening, which

influence their willingness to undergo or recommend screening.

ANC (Antenatal Care): A specialized healthcare service provided to pregnant women to ensure

their health and the health of their unborn babies, which includes regular check-ups, education,

and screening services such as breast cancer screening.

 CHAPTER TWO

LITERATURE REVIEW

This chapter critically examines relevant literature that would assist in explaining the research

problem and furthermore recognize the efforts of scholars who had previously contributed

immensely to similar research. The chapter intends to deepen the understanding of the study and

close the perceived gaps.

Precisely, the chapter will be considered in three sub-headings:

 Conceptual Framework

 Theoretical Framework and

 Empirical Review of Related Literature

2.1 CONCEPTUAL FRAMEWORK

The Global Burden of Cancer

Low and middle-income countries (LMICs) confront the twin epidemiological challenges of

communicable illnesses and chronic non-communicable diseases (NCDs) (Okomo et al., 2019).

The difficulties and disparities encountered by LMICs in addressing these epidemiological issues

are shown by their battle with cancer (George et al., 2019). Data from 2005 to 2015 indicate that

the percentage of mortality attributable to non-communicable diseases (NCDs) increased

worldwide from 65% to 71% (Abiodun et al., 2022). Between 2005 and 2015, cancer-related

fatalities rose from 14% to 16% (Madhu et al., 2021). Conversely, fatalities attributed to

communicable, maternal, neonatal, and nutritional diseases declined from 26% to 20%

(Ogunmodede et al., 2022). The primary causes contributing to this changed disease burden are

the extended lifespan of people, the "modernisation" of lifestyles leading to heightened exposure
to various chronic disease risk factors, and enhanced medical treatments (Heena et al., 2019).

The global health community has addressed the rising threat of non-communicable diseases

(NCDs) through various initiatives, including the 2011 United Nations Political Declaration on

NCD Prevention and Control (WHO, 2018, cited by Meshkani et al., 2022), the World Health

Organization's Global Action Plan for the Prevention and Control of NCDs 2013-2020 (WHO,

2020, cited by Otti et al., 2022), and the incorporation of NCDs into the Sustainable

Development Goals (Theeb et al., 2023).

Cancer is a significant public health challenge in both high-income countries (HIC) and low- and

middle-income countries (LMICs). The incidence of cancer is anticipated to increase

significantly in low- and middle-income countries (LMICs) as a result of the epidemiological

shift, hence exacerbating the burden on their constrained healthcare resources (Onwuchekwa et

al., 2021). Effective resource allocation for cancer prevention, early detection, and both curative

and palliative treatment need comprehensive understanding of the local cancer burden. Data

from the Global Burden of Disease (GBD, 2015) indicate that while age-standardised incidence

rates for all cancers collectively rose in 174 of 195 countries or territories from 2005 to 2015,

age-standardised death rates (ASDRs) for all cancers combined declined in 140 of 195 countries

and territories (Adetona et al., 2021). The GBD research highlighted a significant deficiency in

cancer prevention initiatives, including tobacco regulation, Human Papilloma Virus vaccine, and

the encouragement of physical exercise and a nutritious diet (Irani et al., 2021). In 2015, there

were 17.5 million cancer diagnoses globally and 8.7 million fatalities. The research indicates that

from 2005 to 2015, cancer incidence rose by 33%, attributed to population ageing (16%),

population growth (13%), and changes in age-specific rates (4%) (Maitanmi et al., 2023).

Prostate cancer was the most prevalent cancer worldwide, with 1.6 million cases; however,
malignancies of the trachea, bronchus, and lung accounted for the highest number of cancer-

related fatalities in males, with 1.2 million deaths. In females, breast cancer was the most

prevalent malignancy for both morbidity (2.4 million cases) and mortality (523,000 deaths)

(GBD, 2015, quoted by Adesokan et al., 2021).

Breast Cancer: An Overview

Breast cancer is a significant health concern worldwide, impacting women across all

socioeconomic and cultural divides. It is characterized as a malignant tumor originating in the

cells of the breast, capable of invading surrounding tissues and spreading to other parts of the

body. This condition has drawn global attention due to its increasing prevalence, as highlighted

by Abiodun et al. (2022), who emphasize the critical need for awareness to mitigate its impact.

Breast cancer begins when abnormal changes occur in the genetic material of breast cells,

leading to uncontrolled growth and the formation of tumors. While most breast cancers originate

in the ducts (ductal carcinoma) or lobules (lobular carcinoma), they can also arise in other breast

tissues, as noted by Heena et al. (2019). Understanding the cellular and molecular mechanisms

underlying the disease is essential for developing preventive and diagnostic measures.

The disease is commonly categorized into different types based on the cells affected and the

extent of spread. Meshkani et al. (2022) underscore the importance of distinguishing between

non-invasive and invasive breast cancers. Non-invasive types, such as ductal carcinoma in situ

(DCIS), are confined to the ducts and have not yet invaded surrounding tissues. In contrast,

invasive breast cancers, such as invasive ductal carcinoma (IDC) and invasive lobular carcinoma

(ILC), have spread beyond the ducts or lobules, posing a greater threat to health outcomes.
Globally, breast cancer remains the most frequently diagnosed cancer among women, a trend

mirrored in Nigeria. Adesokan et al. (2021) describe breast cancer as a pressing public health

issue, with its high incidence rates necessitating a robust understanding of its biology and

progression. Studies have shown that the disease disproportionately affects women in developing

countries, where limited access to healthcare resources exacerbates late detection and poor

outcomes. Awareness and education about breast cancer are pivotal in addressing the disease’s

burden. George et al. (2019) emphasize that early detection through clinical breast examinations,

mammography, and breast self-examination significantly improves survival rates. However,

cultural stigmas, fear, and inadequate healthcare infrastructure often hinder early screening

efforts in many communities, as noted by Bamidele et al. (2024).

Advancements in imaging and diagnostic tools have enhanced the detection and staging of breast

cancer. Irani et al. (2021) highlight the role of diagnostic techniques such as mammograms,

ultrasounds, and biopsies in accurately identifying the disease's stage and severity. These

methods not only guide treatment decisions but also empower patients through informed choices

about their care. The biological heterogeneity of breast cancer makes it a complex disease,

requiring tailored approaches to diagnosis and treatment. Odedina et al. (2019) stress the

importance of recognizing genetic and environmental factors that influence the disease's onset

and progression. This understanding has spurred innovations in genetic testing and biomarker

research, which aim to identify individuals at high risk and guide precision medicine.

The National Breast Cancer Foundation (NBCF, 2015), as referenced by Onwuchekwa et al.

(2021), states that the precise aetiology of breast cancer remains unidentified; yet, several

predisposing factors may be associated with its development. Approximately one-third of

postmenopausal breast cancers in those over 50 years are influenced by modifiable behavioural
variables, including obesity and physical inactivity. The administration of menopausal hormones

such as oestrogen is thought to enhance cellular proliferation, leading to DNA damage and

facilitating the formation of cancer cells (Irani et al., 2021). Alcohol use, early menarche, late

menopause, and a familial history of breast or other cancers are associated with an increased risk

of developing breast cancer (Meshkani et al., 2022). Studies indicate that obese women,

particularly those who are postmenopausal, have a 20-40% heightened risk of getting breast

cancer relative to their normal-weight counterparts of the same age (Heena et al., 2019).

Additionally, genetic predispositions, including hereditary mutations in BRCA1 and BRCA2, are

recognised as the most vulnerable genes associated with breast cancer (Adetona et al., 2021).

Women who started menstruation before the age of 12 exhibit around a 20% elevated risk of

breast cancer compared to those who began menstruating after the age of 14. George et al. (2019)

assert that early exposure to oestrogen via early menstruation increases the duration of breast

tissue exposure to oestrogen, a recognised risk factor for breast cancer development. Insufficient

nursing increases the risk of breast cancer. Mothers who breastfeed their infants for up to six

months are therefore at a reduced risk of developing breast cancer compared to those who have

never nursed (Theeb et al., 2023).

Bamidele et al. (2024) shown that breastfeeding effectively reduces the incidence of oestrogen

receptor-negative breast cancers. Caucasian and African American women have a greater risk of

having breast cancer compared to Hispanic women, since the latter are more inclined to bear

children at a younger age than their Caucasian and African American counterparts (Abiodun et

al., 2022). Pregnancy beyond the age of 30 and the onset of menopause post-55 results in

prolonged oestrogen exposure in later life, hence increasing the risk of breast cancer

(Ogunmodede et al., 2022). Women under 40 years of age, namely African American and
African-born immigrants, have elevated breast cancer rates relative to their Caucasian

counterparts (Adesokan et al., 2021). The disparities are attributed to race and ethnicity, maybe

linked to reproductive and lifestyle variables. Nonetheless, these results are equivocal and are

under research (Madhu et al., 2021).

The Worldwide Impact of Breast Cancer

Breast cancer ranks as the second most prevalent cancer overall and is the most prevalent cancer

among women. In 2012, it was predicted that there were 1.67 million new instances of breast

cancer, constituting 25% of all newly diagnosed cancer cases globally (Odedina et al., 2019).

Breast cancer is the most prevalent malignancy among women globally, with an estimated

883,000 cases in low- and middle-income countries (LMICs) and 794,000 cases in more

economically developed areas in 2012 (Bamidele et al., 2024).

The primary risk factors for breast cancer include individual characteristics such as race and

ethnicity, excess weight and obesity, lack of physical exercise, alcohol use, and tobacco use. The

risk of breast cancer may markedly elevate for those with first-degree relatives diagnosed with

the disease and for those exhibiting heightened breast density. Reproductive risk variables

include early menarche, nulliparity, advanced maternal age at first birth, absence of nursing, oral

contraceptive use, menopausal status, and menopausal hormone treatment (Okomo et al., 2019).

In several low- and middle-income countries, changes in reproductive variables, lifestyle, and

enhanced life expectancy have resulted in a significant increase in breast cancer incidence

(Onwuchekwa et al., 2021).

Plans for breast cancer prevention are often included into comprehensive national cancer control

programs, which are, in turn, generally integrated into non-communicable disease preventative
plans (Irani et al., 2021). Comprehensive cancer control measures include prevention, early

detection, diagnosis and treatment, rehabilitation, and palliative care (Adetona et al., 2021).

Essential measures for population-based breast cancer control include enhancing public

knowledge of breast cancer, promoting suitable policies and programs, and refining systems for

disease management (Abiodun et al., 2022). The LMICs, which face the dual burden of breast

and cervical cancer as the highest killers among women, need to implement combined strategies

that address both of these public health problems through effective and efficient interventions so

that these preventable diseases can be successfully tackled (Theeb et al., 2023). While risk

preventive efforts may produce modest risk reductions, these techniques cannot eradicate the

majority of breast cancers. Therefore, early identification remains the cornerstone of breast

cancer management in order to enhance outcomes and survival (George et al., 2019).

Concept of Breast Cancer Screening

Breast cancer screening is the use of particular tests to identify breast cancer in its first and most

manageable phases. Screening is an essential element of global cancer prevention initiatives.

Madhu et al. (2021) assert that efficient screening techniques, including mammography and

clinical breast exams, are crucial for detecting breast abnormalities in asymptomatic persons.

Notwithstanding its advantages, the execution and availability of these tests differ markedly

among areas. In rural India, deficiencies in knowledge and infrastructure constraints impede

extensive involvement (Madhu et al., 2021). This highlights the need for focused teaching

programs that stress the significance of early detection. Systematic assessments from Arab

nations also underscore differences in access to screening methods, often exacerbated by social

influences and obstacles in resource allocation (Theeb et al., 2023). These results highlight the
worldwide inequalities in the implementation of screening and the need for tailored

interventions.

The advancement of breast cancer screening methodologies remains a central concern in public

health research. Ogunmodede et al. (2022) recognize an expanding corpus of work that

investigates the impact of awareness campaigns and training programs on enhancing screening

uptake. In Nigeria, where breast self-examination is widely performed, there exists a substantial

possibility to augment knowledge via organized interventions. Bamidele et al. (2024) contend

that targeted initiatives inside prenatal clinics might function as an efficient medium for

conveying information on breast cancer screening. Their research in Akodo town shown that

including breast cancer education into standard maternal health care enhances the probability of

early diagnosis. This integration enables women, particularly those of reproductive age, to make

educated health choices, therefore closing knowledge gaps.

Furthermore, research has investigated the efficacy of several breast cancer screening methods.

Mammography is the gold standard because of its sensitivity in identifying non-palpable lesions.

Adesokan et al. (2021) indicate that the elevated cost and restricted accessibility of

mammography equipment in low-resource environments impede its use. Clinical breast exams

and breast self-examinations have been advocated as effective methods to overcome these

obstacles. Odedina et al. (2019) examine the influence of instructional sessions on enhancing

compliance with breast self-examination, particularly among pregnant and breastfeeding women

in Nigeria. These workshops enhance knowledge and foster confidence in identifying early

indicators of problems. These results underscore the importance of community-based education

and empowerment activities in enhancing screening behaviours.

The systematic study by Meshkani et al. (2022) underscores the need of integrating screening

techniques with cultural and demographic circumstances. Their examination of worldwide

patterns revealed that women's knowledge and attitudes are often influenced by their immediate

surroundings. This aligns with the results of George et al. (2019), who underscored the need for

awareness efforts to confront local myths and taboos to achieve efficacy. By customising

treatments to the specific requirements of diverse groups, public health initiatives may markedly

improve screening participation and aid in decreasing breast cancer death rates. Thus, breast

cancer screening is a complex and evolving domain of public health, necessitating ongoing study

and flexible techniques to address the demands of varied populations.

Importance of Breast Cancer Screening

Breast cancer screening is crucial for early detection, which significantly enhances the likelihood

of effective treatment. Madhu et al. (2021) assert that early diagnosis of breast cancer with

frequent screening facilitates prompt medical intervention, which may save lives and mitigate the

long-term economic and emotional costs associated with advanced cancer treatment. Regular

screening facilitates early breast cancer detection and enhances women's knowledge of the

illness, promoting proactive health behaviours. This is especially crucial in areas with restricted

access to healthcare services, where late-stage diagnoses are more common. Mammography,

clinical breast exams, and breast self-examinations are essential elements of early detection

measures, facilitating the identification of cancer prior to its advancement to more severe stages

(Madhu et al., 2021).

Theeb et al. (2023) underscore the significance of breast cancer screening in mitigating

healthcare outcome inequities among women, especially in resource-limited environments. Their

comprehensive study emphasizes that the implementation of extensive screening programs may
ameliorate disparities in breast cancer outcomes by ensuring equal access to early diagnostic

resources. Cultural constraints and inadequate resources have long impeded the use of screening

in Middle Eastern Arab nations. Targeted awareness efforts and accessible screening facilities

have shown potential in enhancing participation rates. Screening promotes a culture of health-

seeking behaviour, especially among communities who have been historically underserved or

uninformed about the advantages of early diagnosis. This highlights the need for customised

initiatives that tackle local obstacles and promote women's participation in routine screening

procedures (Theeb et al., 2023).

Ogunmodede et al. (2022) emphasise the importance of breast cancer screening in reducing the

elevated death rates linked to late-stage diagnosis in Nigeria. Their analysis of breast self-

examination behaviours indicates that insufficient knowledge and adverse attitudes towards

screening persist as significant obstacles. However, the research indicates that community-based

educational initiatives might improve the uptake of screening practices, especially in rural and

peri-urban regions. Ogunmodede et al. (2022) emphasise that incorporating breast cancer

screening within current healthcare frameworks, such as prenatal clinics, provides an effective

method for accessing a larger female population. This enhances early detection rates and

corresponds with overarching public health objectives of decreasing cancer-related mortality and

fostering preventative healthcare behaviours. These efforts illustrate the transformational

capacity of breast cancer screening in enhancing women's health outcomes in many contexts.

Breast Cancer Screening Modalities

Breast Self-Examination
The objective of BSE is to encourage women to become acquainted with the typical appearance

and texture of their breasts. As noted by the CDC (2017) in the work of Onwuchekwa et al.

(2021), a woman's awareness of the shape and texture of her breasts can aid in the early detection

of symptoms, including lumps, discomfort, or alterations in size. It is imperative that they

promptly communicate any alterations to their healthcare providers. It is advisable for women to

begin conducting breast self-examinations monthly from the age of 20, ideally following their

menstrual period when breast tenderness or swelling is minimised. Consultation with a health

care provider may be beneficial for guidance on the appropriate methods of breast examination

and the key indicators to observe. Nevertheless, studies indicate that there is minimal evidence

supporting the notion that this test is effective in detecting breast cancer at an early stage when

compared to a mammogram (Adetona et al., 2021).

Clinical Breast Examination

A clinical breast examination (CBE) is a physical assessment of the breast performed by a

healthcare provider, typically during a woman's routine physical check-up. Otti et al. (2022)

indicate that the National Comprehensive Cancer Network (NCCN) advises that a qualified

provider should meticulously examine the woman’s breasts, underarms, and regions beneath the

clavicle for any changes or abnormalities such as lumps. The woman adopts various postures,

both seated and supine, during the visual and tactile assessment of the breasts. Women should

feel empowered to ask for a clinical breast examination if their healthcare providers do not

regularly include it in their annual physical assessments. The NCCN (2017), as referenced by

George et al. (2019), advised that individuals should undergo annual clinical breast examinations

starting at the age of 25, continuing this practice alongside mammography. CBE has the potential

to identify early palpable indicators of breast cancer, which may facilitate timely intervention. A
deviation in the clinical breast examination or a false positive finding necessitates further

investigation through a mammogram to assess for breast cancer (Abiodun et al., 2022). It is

important to highlight that the American Cancer Society does not endorse CBE for breast cancer

screening due to a lack of adequate scientific evidence supporting its efficacy as an early

detection method for breast cancer (Irani et al., 2021).

Mammogram

A mammogram is an x-ray examination of the breast tissues. The method is widely regarded as

the most effective and dependable approach for breast cancer screening (Madhu et al., 2021).

The ACS advises that women at elevated risk for breast cancer, particularly those with a family

history involving mothers or siblings diagnosed with the disease, should commence annual

mammograms between the ages of 40 and 54. Starting at the age of 55, women have the option

to either maintain their annual mammogram schedule or transition to a biennial approach. The

continuation of this test is warranted if the woman demonstrates good health and is anticipated to

have a life expectancy of 10 years or more (Okomo et al., 2019). It is advised that women who

possess an average risk of breast cancer begin annual mammograms between the ages of 45 and

54. It is advisable for them to persist with these evaluations every two years starting at the age of

55. An annual mammogram serves as a crucial tool for the early detection of breast cancer, often

before any physical symptoms manifest. Research indicates that early detection of breast cancer

through mammography is associated with a reduced likelihood of aggressive treatment options

such as mastectomy and chemotherapy. Furthermore, the likelihood of achieving a cure is

notably elevated (Theeb et al., 2023). Nonetheless, the U.S. Preventive Services Task Force, a

panel of experts dedicated to evaluating research outcomes, has advised that mammograms

should commence at the age of 50, in alignment with the recommendations of the American
College of Physicians, and persist until the age of 74. No evidence of benefit is observed in

individuals aged 75 years and older (Maitanmi et al., 2023).

Knowledge of Breast Cancer Screening

Comprehension of breast cancer screening includes awareness of its risk factors, first symptoms,

and screening techniques. Madhu, Sathish, and Vinay Kumar (2021) assert that information

underpins the adoption of preventative interventions, empowering people to make educated

health choices. Understanding the recommended screening techniques, including mammography,

clinical breast examination (CBE), and self-breast examination (SBE), is essential for decreasing

breast cancer morbidity and mortality. Theeb et al. (2023) contend that comprehending the ideal

frequency and initiation age for screening is crucial for early detection and intervention.

Nonetheless, despite widespread knowledge of breast cancer, misunderstandings about its

screening persist, often stemming from insufficient distribution of proper information (Bamidele,

Egonu, & Oladejo, 2024). These findings highlight that a thorough comprehension of breast

cancer screening improves patients' capacity to recognise possible signs and pursue prompt

medical intervention, especially among at-risk groups such as mothers visiting prenatal clinics.

The understanding of breast cancer screening among mothers varies considerably, shaped by

many social and educational variables. Ogunmodede et al. (2022) identified education and access

to credible health information as fundamental predictors of knowledge levels. Mothers visiting

prenatal clinics constitute a vital demographic for health interventions owing to their regular

healthcare engagements. Adesokan et al. (2021) emphasise that this cohort often exhibits

intermediate levels of knowledge, with variations between urban and rural environments. In
remote regions, little exposure to healthcare initiatives intensifies knowledge deficiencies, as

shown by Meshkani et al. (2022). Additionally, a study by Abiodun et al. (2022) indicates that

healthcare practitioners in metropolitan areas possess greater expertise than those in rural

locations. The results indicate that while prenatal clinics provide a venue for health education,

substantial efforts are necessary to address knowledge gaps and improve awareness among

mothers in various circumstances.

Obstacles to obtaining information about breast cancer screening continue to pose a substantial

barrier, especially in resource-constrained environments. Otti et al. (2022) observe that

inadequate literacy skills in women often obstruct their comprehension of health-related

information, such as breast cancer screening. Cultural ideas and stigmatisation related to cancer

inhibit open discourse and education on the topic (Odedina et al., 2019). Scarce healthcare

resources, including a deficiency of skilled personnel and insufficient screening facilities, further

impede access to information (Bamidele, Egonu, & Oladejo, 2024). Moreover, Okomo, Owenga,

and Onguru (2019) underscore the impact of disinformation in sustaining anxieties and

misunderstandings, resulting in an aversion to participating in screening activities. The absence

of customised training programs aimed at certain groups, such as moms visiting maternity

clinics, intensifies the problem. Overcoming these obstacles requires coordinated initiatives to

enhance health literacy and implement culturally relevant treatments, as emphasised by Irani et

al. (2021). These findings highlight the need of surmounting barriers to guarantee that women,

especially in marginalised communities, can get precise and practical information on breast

cancer screening.

Attitudes Towards Breast Cancer Screening

Perceptions of breast cancer screening are crucial in influencing women's involvement in early

detection initiatives. Attitudes include ideas, emotions, and inclinations, constituting a vital

component of health-seeking behaviours. Madhu, Sathish, and Kumar (2021) assert that a

favourable disposition towards screening is associated with heightened compliance to prescribed

procedures. Women with positive views are more like to see screening as advantageous, hence

prioritising their health. A negative attitude stemming from fear or ignorance diminishes

involvement, delaying diagnosis and treatment. This underscores the need of confronting

attitudinal obstacles to enhance screening rates and results.

Several studies highlight that while some Nigerian women exhibit positive attitudes toward

screening, many others show reluctance or apathy. Adesokan et al. (2021) observed that young

women in Abuja recognized the importance of screening but were often hesitant to undergo

procedures due to uncertainty about their necessity. Similarly, Onwuchekwa et al. (2021)

reported that despite widespread awareness of screening methods, a significant number of

women expressed apprehension or ambivalence towards utilizing these services. Ogunmodede et

al. (2022) further noted that these attitudes reflect a gap between knowledge and practical uptake

of screening practices. A significant proportion of Nigerian women demonstrate a cautious or

indifferent attitude towards breast cancer screening. George et al. (2019) found that women in

urban and semi-urban areas expressed skepticism about the efficacy of screening, often

associating it with unnecessary medical procedures. Heena et al. (2019) corroborated this

finding, revealing that even among healthcare professionals, attitudes toward screening were not

always favorable due to perceived inconvenience or discomfort associated with the procedures.

Abiodun et al. (2022) emphasized that such attitudes often lead to delays in early detection,

undermining the benefits of regular screening.

Factors Influencing Attitudes Towards Breast Cancer Screening

Perceived Risk of Breast Cancer: The impression of vulnerability profoundly influences

attitudes towards breast cancer screening. Women who acknowledge their susceptibility are more

likely to pursue early detection. Theeb et al. (2023) assert that awareness campaigns emphasising

risk factors may promote a proactive stance towards screening. Nevertheless, the research

indicates that diminished perceived risk among certain groups leads to complacency, despite

recognised family or lifestyle risk factors. Interventions that improve risk perception are essential

for closing this attitudinal gap and promoting involvement.

Cultural and Religious Beliefs: Cultural and religious customs significantly influence

perceptions of breast cancer screening. Ogunmodede et al. (2022) indicate that in Nigeria, socio-

cultural stigmas often inhibit women from pursuing screening services. Perceptions of bodily

privacy and misunderstandings about cancer may dissuade women, especially in rural regions.

Adesokan et al. (2021) contend that religious interpretations have a dual function, either

facilitating or obstructing health behaviours based on their alignment with health messages.

Customised education that honours cultural and religious beliefs helps alleviate these issues.

Trust in Healthcare Providers: The degree of trust in healthcare institutions and practitioners

profoundly influences perceptions of breast cancer screening. Women who possess trust in

medical practitioners are more inclined to engage in frequent screenings (Odedina et al., 2019).

Conversely, scepticism or previous adverse experiences may dissuade women from pursuing

services. Bamidele, Egonu, and Oladejo (2024) emphasise the need of educating healthcare

professionals to establish rapport and offer culturally appropriate treatment, hence establishing

trust and promoting adherence.

Antenatal Clinics as Platforms for Breast Cancer Education

Antenatal clinics function as essential venues for providing health education to women

throughout pregnancy, including information about breast cancer and related screening

procedures. These clinics provide a valuable chance to include breast cancer awareness into

maternity healthcare, ensuring that women of reproductive age recognise the significance of

early diagnosis. Madhu, Sathish, and Vinay Kumar (2021) assert that comprehensive health

education programs conducted in prenatal settings may markedly enhance knowledge and

attitudes towards breast cancer screening. Their research emphasises that women in rural regions,

who may have restricted access to information, get significant advantages from focused

treatments provided during maternity visits. Likewise, Theeb et al. (2023) assert that prenatal

clinics are distinctly equipped to tackle cultural and informational obstacles to screening,

promoting a proactive approach to breast health. Incorporating breast cancer education into

prenatal care enhances maternal health outcomes and extends these advantages to families and

communities.

Ogunmodede et al. (2022) further substantiate the function of prenatal clinics in promoting

health-seeking behaviour among women, noting that pregnant women who use these clinics have

elevated health awareness. These clinics often serve as the first point of contact for many women

with the official healthcare system, especially in impoverished areas. Bamidele, Egonu, and

Oladejo (2024) assert that the organised setting of prenatal clinics enables healthcare personnel

to methodically impart instruction and rectify misunderstandings about breast cancer. This

proactive strategy enables women to make educated health choices more effectively.

Effectiveness of Antenatal Clinics in Promoting Screening

The efficacy of prenatal clinics in facilitating breast cancer screening is attributed to their

capacity to engage a receptive demographic of women already using the healthcare system. Otti

et al. (2022) indicate that prenatal visits provide an optimal environment for imparting breast

cancer screening education, since pregnant women generally exhibit heightened receptivity to

health information during this time. The research indicated that women who received breast

cancer education during prenatal appointments were more inclined to do self-breast exams and

engage in mammography screening after pregnancy.

Adesokan et al. (2021) substantiate this by demonstrating that prenatal health education sessions

result in a significant enhancement in breast cancer awareness and screening participation among

women. Odedina et al. (2019) discovered that instructional sessions on breast self-examination

during prenatal treatment significantly enhanced compliance with screening practices among

pregnant and breastfeeding women. These results correspond with the conclusions of Abiodun et

al. (2022), who noted that educational interventions in maternity clinics are crucial for closing

the information gap and alleviating anxieties related to breast cancer screening.

Meshkani et al. (2022) emphasise that prenatal clinics are especially proficient in incorporating

culturally appropriate teaching that appeals to varied communities. The organised framework of

prenatal care guarantees uniform communication, which, as highlighted by George et al. (2019),

is crucial for promoting enduring health behaviour modification. Antenatal clinics may enhance

views of breast cancer screening and promote universal adoption of preventative measures by

capitalising on the confidence women have in healthcare professionals.

2.2 THEORETICAL REVIEW

Health Belief Model (HBM)

The health belief model (HBM) is a social psychological health behavior change model

developed to explain and predict health-related behaviors, particularly in regard to the uptake of

health services (Siddiqui et al.,2016). The health belief model also refers to an individual’s

beliefs about preventing diseases, maintaining health, and striving for well-being (Wang et

al.,2024). The HBM was developed in the 1950s by social psychologists at the U.S. Public

Health Service and remains one of the best known and most widely used theories in health

behavior research. The HBM suggests that people’s beliefs about health problems, perceived

benefits of action and barriers to action, and self-efficacy explain engagement (or lack of

engagement) in health-promoting behavior A stimulus, or cue to action, must also be present in

order to trigger the health-promoting behavior (Wang et al.,2024)

The HBM is a widely used framework to understand health behaviors, especially screening

behaviors. It is particularly relevant for understanding the attitudes and decisions regarding

preventive health practices such as breast cancer screening.

Perceived Susceptibility: Mothers attending antenatal clinics may assess their personal risk for

breast cancer. Educating them on how breast cancer can affect women of all ages, including

those without a family history, is essential.

Perceived Severity: How serious do mothers perceive breast cancer to be? The more serious they

believe breast cancer is, the more likely they may engage in screening.

Perceived Benefits: Mothers are more likely to engage in breast cancer screening if they

understand the benefits of early detection, such as increased survival rates and better treatment

outcomes.
Perceived Barriers: Barriers could include lack of time, fear, or misconceptions about screening.

Addressing these concerns through counseling or providing affordable options can improve

screening uptake.

Cues to Action: Interventions such as health education sessions, reminders from healthcare
providers during antenatal visits, and peer support groups can act as cues to encourage screening.

Self-Efficacy: Increasing mothers’ confidence in their ability to undergo screening, addressing

fears, and providing clear instructions on how to perform self-examinations or access clinical

screening are crucial.

Figure 2.1 Diagram Illustration of Health belief model

Application of Health Belief Model to Breast cancer

Application of the Health Belief Model (HBM) to Knowledge and Attitude Towards Breast

Cancer Screening Among Mothers Attending Antenatal Clinics in LASUTH

The Health Belief Model (HBM) is a psychological framework that explains and predicts health

behaviors by focusing on individuals’ beliefs and attitudes.

Perceived Susceptibility: The belief about the likelihood of developing breast cancer. Educating

mothers about their risk of developing breast cancer, even during childbearing years, can

increase awareness. Providing statistics, such as the prevalence of breast cancer in Nigeria, helps

emphasize susceptibility.

Perceived Severity: The belief about the seriousness of breast cancer and its consequences.

Explain the potential consequences of late detection, such as reduced treatment success and

higher mortality rates. Share testimonials or case studies to highlight the impact of delayed

diagnosis and the benefits of early detection.

Perceived Benefits: The belief that taking action (e.g., screening) will reduce the risk of breast

cancer or its severity. Highlight the effectiveness of early detection methods like self-breast

examination (SBE), clinical breast examination (CBE), and mammography in improving survival

rates. Discuss how screening can empower mothers to take control of their health.

Perceived Barriers: The belief about obstacles to engaging in breast cancer screening. Identify

barriers such as fear of results, lack of knowledge about screening methods, cost, or time

constraints. Offer solutions, such as free or low-cost screening programs, integration of breast

screening with antenatal care, and emotional support for overcoming fear.

Cues to Action: Triggers that motivate individuals to take health-related action. Use reminders

during antenatal visits to encourage mothers to undergo breast cancer screening. Provide

informational brochures, posters, or group education sessions at LASUTH to prompt action.

Leverage community campaigns or social media to increase awareness about breast cancer

screening.
Self-Efficacy: Confidence in one’s ability to perform the required action. Train mothers on how

to perform self-breast examinations (SBE) confidently. Provide demonstrations and step-by-step

guides for self-screening. Reassure them about the availability of professional support for

clinical breast examinations.

Summary of HBM Application to Knowledge and Attitude

The HBM helps identify and address gaps in mothers’ knowledge and attitudes towards breast

cancer screening at LASUTH. By improving their understanding of susceptibility and severity,

emphasizing the benefits of screening, reducing perceived barriers, and enhancing self-efficacy,

the model fosters positive attitudes and encourages proactive behavior.

2.3 EMPIRICAL REVIEW

Madhu, Sathish, & Vinay Kumar (2021) conducted a study titled “A Study to assess the

knowledge attitude and practice regarding Breast Cancer screening among Women in

reproductive age (15-45 years) in selected rural areas of Chamarajanagar district with a view to

develop educational programme.” The study aimed to evaluate the levels of knowledge, attitudes,

and practices regarding breast cancer screening among rural women and to develop an

educational program based on the findings. A descriptive cross-sectional survey design was used,

with a population comprising 200 women aged 15–45 years from rural Chamarajanagar. Data

were collected using structured questionnaires and analyzed using descriptive and inferential

statistics. Results showed low levels of knowledge (32%) and poor screening practices (18%),

while 50% of participants had a positive attitude toward screening. The study concluded that

educational interventions are crucial to enhancing awareness and recommended incorporating

community-based health education programs.

Theeb, Al-Kasaji, & Alduraidi (2023) systematically reviewed the “knowledge, attitudes, and

practices toward breast cancer and breast cancer screening among females in Arab countries of

the Middle East.” The objective was to evaluate the factors influencing screening behaviors in

Arab women. Using a systematic literature review method, the study analyzed 15 peer-reviewed

articles published between 2010 and 2022. Findings revealed substantial knowledge gaps, with

only 25% of women aware of early detection methods and fewer than 30% engaging in regular

screening practices. Barriers included cultural beliefs and fear of diagnosis. The review

concluded that tailored public health strategies are needed and recommended government-funded

awareness campaigns to improve uptake of screening services.

Ogunmodede, Aluko, & Anorkwuru (2022) conducted “Knowledge, Attitude and Practice of

Breast Self-Examination in Nigeria: A 10 Year Systematic Review.” The study aimed to assess

trends in knowledge, attitudes, and practices regarding breast self-examination (BSE) among

Nigerian women. A systematic review of 20 studies published between 2012 and 2022 was

carried out. Data analysis revealed that while 60% of women had some knowledge of BSE, only

22% practiced it regularly. Negative attitudes, including perceptions of irrelevance and fear, were

prevalent. The review concluded that targeted educational efforts are essential and recommended

integrating BSE education into routine healthcare visits.

Bamidele, Egonu & Oladejo (2024) examined “Knowledge and screening practices for breast

cancer among women of reproductive age in Akodo town, Lagos, Nigeria.” This cross-sectional

study aimed to identify knowledge levels and screening practices. A total of 300 women aged

18–45 years participated, with data collected through structured interviews. Analysis using chi-

square tests revealed a significant relationship between education level and screening knowledge

(p<0.05). Despite 68% of women expressing positive attitudes, only 21% had undergone any
form of screening. The study concluded that limited healthcare access was a major barrier and

recommended mobile screening units in rural areas.

Adesokan et al. (2021) explored “Breast Cancer Screening: Knowledge, Attitude and Practice of

Female Youths in Lugbe Community of Abuja, Nigeria.” The study aimed to assess breast cancer

awareness and screening behaviors among young women. A cross-sectional survey involving 250

participants aged 15–25 years was conducted using structured questionnaires. Data analysis

revealed that 42% of participants were knowledgeable about breast cancer, but only 15%

engaged in screening practices. Cultural stigma and lack of perceived risk were cited as major

barriers. The study concluded that targeted youth-friendly awareness programs are essential for

improving screening uptake.

Odedina et al. (2019) investigated the “Influence of a Teaching Session on Breast Self-

Examination and Adherence Among Pregnant and Lactating Women in Ibadan, Nigeria.” The

study aimed to evaluate the impact of educational interventions on BSE adherence. Using a

quasi-experimental design, 150 pregnant and lactating women participated, with pre- and post-

intervention surveys administered. Data analysis showed a significant improvement in BSE

knowledge (from 38% to 78%) and practice adherence (from 20% to 65%) post-intervention.

The study concluded that targeted education significantly impacts BSE adherence and

recommended integrating such programs into maternal healthcare services.

2.4 SUMMARY OF LITERATURE REVIEW

The reviewed literature explored the burden, and risk factor of breast cancer. It further elaborated

on breast cancer screening as a preventive measure, while discussing women’s knowledge,

attitude, and factors influencing their attitude towards breast cancer screening in Nigeria and
beyond. The Knowledge, Attitude, and Practice (KAP) was chosen as the framework to provides

a theoretical lens to understand the dynamics of breast cancer screening behaviors, emphasizing

the interconnectedness of awareness, beliefs, and actions (Otti et al., 2022). Empirical evidence,

such as the study by Madhu et al. (2021), reveals significant gaps in knowledge and low

screening practices among rural women, highlighting the need for targeted educational

interventions. Similarly, systematic reviews by Theeb et al. (2023) and Ogunmodede et al. (2022)

confirm persistent barriers to screening, including cultural stigmas, fear, and inadequate

healthcare access, which result in suboptimal uptake of preventive practices. Regional studies,

like those by Bamidele et al. (2024) and Adesokan et al. (2021), identify education and

healthcare accessibility as critical factors influencing knowledge and attitudes, further

reinforcing the need for tailored, community-based strategies to improve outcomes.

Interventions, such as the teaching sessions examined by Odedina et al. (2019), demonstrate the

effectiveness of targeted educational efforts in enhancing screening adherence. Collectively,

these findings highlight the urgency of addressing knowledge deficits, fostering positive

attitudes, and eliminating systemic barriers to breast cancer screening among Nigerian women.
 CHAPTER THREE

METHODOLOGY

3.1 Research Design

This study employed a descriptive cross-sectional research design. The design is particularly

suitable for this study as it allows for a comprehensive assessment of the existing knowledge,

attitudes, and practices of the participants at a specific point in time. This design is widely used

in health research where the aim is to understand the status of a phenomenon and identify

patterns and trends related to behaviors or conditions without any manipulation of variables.

3.2 Research Setting

The study was conducted at Lagos State University Teaching Hospital (LASUTH), located in

Ikeja, Lagos State, Nigeria. LASUTH is one of the leading tertiary healthcare facilities in

Nigeria, offering specialized services in obstetrics and gynecology, pediatrics, and other areas of

healthcare, including antenatal care. The antenatal clinics at LASUTH cater to a large number of

mothers, including both urban and rural women, making it an ideal setting to study the

knowledge and attitudes towards breast cancer screening among a diverse group of women. The

hospital’s antenatal services offer regular prenatal check-ups, health education, and counseling,

which makes it a fitting environment for addressing the research questions related to women’s

health education and screening practices. The setting provided a broad sample of mothers with

varying degrees of knowledge and awareness of breast cancer screening, allowing for an in-depth

exploration of the factors that influence their screening behaviors.

3.3 Target population

The target population for this study consisted of mothers attending antenatal clinics at LASUTH.

The actual population size for the study was based on the most recent data from the antenatal

clinic records, which show that LASUTH services about 489 mothers monthly. This population

size was used to determine the sample size for this study.

3.4 Study Population

Pregnant women attending antenatal clinics at LASUTH, selected to assess their knowledge and

attitude toward breast cancer screening.

3.4.1 Inclusion Criteria:

Pregnant women attending antenatal clinics at LASUTH.
3.4.2 Exclusion Criteria:
Non-pregnant women.
History of breast cancer.
Healthcare professionals.
Decline consent.

3.5 Sampling Size Determination

The sample size was determined using Cochran’s formula:

Where:
is the desired level of precision (margin of error)
is the estimated proportion of the population

is the Z-score corresponding to the chosen confidence level

Since the total population () is finite, the adjusted sample size () is calculated using:

Given:
Thus, the required sample size is 152 pregnant women attending antenatal clinics at LASUTH.
3.6 Sampling Technique

The study adopted a simple random sampling technique to select the participants. In this study,

the strata was based on specific factors such as age, education level, and socio-economic status.

This approach is chosen because it ensures that the sample is diverse and representative of the

various demographic characteristics present in the population. After identifying the strata,

random sampling was employed within each group to select the participants. This ensures that

each mother within the stratum has an equal chance of being selected, which enhances the

generalizability of the study’s findings.

3.7 Instruments for Data Collection

The primary instrument for data collection in this study is a structured questionnaire. The

questionnaire was designed to assess the knowledge, attitude, and practice (KAP) towards breast

cancer screening among mothers attending antenatal clinics at LASUTH. The questionnaire

consisted of three main sections: Section A - contains the Demographic information of the

respondents. Section B - contains items on the knowledge of breast cancer screening; Section C

- contains items on the Attitude towards breast cancer screening, and Section D: contains items

on perceived factors influencing the attitude towards the uptake of breast cancer screening

among mothers attending antenatal clinics. The questionnaire utilized both closed-ended 5-

Likert scale questions.

3.8 Validity of Instrument

In-line with objectives of the study, the self-developed structured questionnaire guide was

submitted to the project supervisor and three experts in the field who carefully study each item of
the instrument and its relevance to the objectives of the study before finally approving the

instrument.

3.9 Reliability of Instrument

To ascertain the reliability of the instrument, the test-retest technique was used. Then instrument

was administered to 10 individuals of comparable characteristics who are not part of the sample

size. These questionnaires was re-administered to the respondents after a period of 1 week to the

same respondents. The first and second results were compiled and analyzed using the

Spearman’s rank order correlation co-efficient.

3.10 Procedure for Data Collection

Data was collected through self-administered questionnaires. Trained research assistants were

assigned to administer the questionnaires to the participants during their visits to the antenatal

clinics at LASUTH. The research assistants was responsible for providing a brief explanation of

the purpose of the study and ensuring that the respondents understand the questions in the

questionnaire. They assisted participants with any queries they may have and ensure that the

responses are recorded accurately.

Before administering the questionnaires, the participants were informed about the study’s

objectives, and their consent was obtained. Participants were also assured that their responses

will be treated with confidentiality and anonymity. Data collection took place over a period of six

weeks to ensure that a sufficient number of participants are included in the study. During this

period, the research assistants were available to answer questions and assist with the completion

of the questionnaires, as needed. After the completion of the data collection process, the
questionnaires were checked for completeness, and the data was organized and prepared for

analysis.

3.11 Method of Data Analysis

The collected data was analyzed using both descriptive and inferential statistical techniques.

Descriptive statistics, such as frequencies, and percentages in the 5 point likert scale format -

Strongly Agree, Agree, Undecided, Disagree and Strongly Disagree, was used to summarize and

present the demographic characteristics of the respondents and their opinions. Inferential

statistics, such as chi-square and logistics regression was used to test the hypotheses. The data

was analyzed using statistical software such as SPSS (Statistical Package for the Social

Sciences). The results were presented in tables, charts, and graphs for easy interpretation.

3.12 Ethical considerations

The study was approved by the Project Committee of the Department. Informed consent was

obtained from all study participants before they were enrolled in the study. Permission was

sought from the relevant authorities to carry out the study. Date to visit the place of study for

questionnaire distribution was put in place in advance.

 CHAPTER FIVE

SUMMARY OF FINDINGS, CONCLUSION AND RECOMMENDATIONS

5.1 Findings of the Study

Knowledge of Breast Cancer Screening Among Mothers Attending Antenatal Clinics in

LASUTH
The findings from this study indicate that while a significant proportion of respondents

demonstrated knowledge of breast cancer screening, gaps remain in understanding specific

aspects, such as the role of family history and the importance of screening even in the absence of

symptoms. For instance, a notable percentage of respondents incorrectly believed that breast

cancer can only be detected when symptoms appear. However, most mothers acknowledged the

effectiveness of breast self-examination (BSE) and its role in early detection. The results also

highlighted that breastfeeding is widely recognized as a protective factor against breast cancer,

reflecting a basic awareness of risk-reducing strategies. These findings align with existing

literature on the subject. Madhu, Sathish, and Vinay Kumar (2021) found that only 32% of

women in their study had adequate knowledge of breast cancer screening, indicating a

widespread lack of awareness, particularly in rural areas. Similarly, Theeb et al. (2023) reported

that only 25% of women in Arab countries were aware of early detection methods, emphasizing a

global challenge in breast cancer awareness. The similarity between this study and these previous

findings underscores the need for targeted educational interventions to enhance knowledge and

dispel misconceptions.

Attitude Towards Breast Cancer Screening Among Mothers Attending Antenatal Clinics in
LASUTH
The study revealed that most respondents had a positive attitude toward breast cancer screening,

with a majority agreeing that it is an essential health measure for women. Many respondents
expressed willingness to undergo screening if recommended by a healthcare provider, suggesting

that professional advice plays a crucial role in influencing health behaviors. However, a small

fraction of respondents felt that screening was unnecessary unless symptoms were present,

highlighting the need for awareness campaigns to reinforce the importance of proactive

screening. These findings correspond with previous studies, such as that of Bamidele et al.

(2024), who reported that while 68% of women expressed positive attitudes toward breast cancer

screening, only 21% had actually undergone screening. This reflects a gap between attitude and

practice that needs to be addressed. Likewise, Ogunmodede et al. (2022) found that despite 60%

of Nigerian women being aware of BSE, only 22% practiced it regularly, indicating that

attitudinal shifts do not always translate into behavioral changes. The findings of this study

reaffirm the necessity of bridging this gap through targeted intervention programs and

community engagement.

Perceived Factors Influencing Attitude Towards the Uptake of Breast Cancer Screening

Among Mothers Attending Antenatal Clinics in LASUTH

Several factors were identified as influencing the uptake of breast cancer screening, including

awareness of risk factors, knowledge levels, fear of diagnosis, cultural beliefs, healthcare

accessibility, and support from healthcare providers. Fear of a breast cancer diagnosis was

particularly notable, with many respondents expressing concern that a positive result could lead

to emotional distress. Cultural beliefs also emerged as a significant barrier, with some women

perceiving screening as unnecessary or fearing societal stigma. However, the study found that

access to affordable and available screening services, as well as encouragement from healthcare

providers, positively influenced screening uptake. These findings are consistent with previous

research. Theeb et al. (2023) identified cultural beliefs and fear of diagnosis as major barriers to
screening in Arab countries, mirroring the concerns raised by respondents in this study. Similarly,

Adesokan et al. (2021) found that stigma and lack of perceived risk were significant deterrents to

breast cancer screening among young women in Nigeria. These parallels indicate that cultural

and psychological barriers to screening are not unique to one region and that targeted educational

interventions, coupled with affordable screening services, are crucial for increasing uptake.

5.2 Implication of Findings to Nursing

1. Health Education and Counseling: The presence of knowledge gaps in critical areas like

inheritance patterns and complications (e.g., priapism, stroke) highlights the need for

nurses to provide targeted health education during routine clinic visits. Educational

materials should be simple, culturally sensitive, and focused on both common and less-

known aspects of SCD.

2. Assessment of Patient Knowledge: Nurses should routinely assess patients’

understanding of SCD through informal questioning or structured tools, to tailor

education based on individual needs and correct misconceptions early.

3. Empowerment for Self-Management: Since most respondents showed moderate to high

knowledge, nurses can leverage this as a foundation for empowering patients to take

greater responsibility in managing their condition through adherence to medications,

hydration, pain management, and preventive strategies.

4. Family and Genetic Counseling: Nurses should actively engage in genetic counseling,

especially for adolescents and young adults, to reinforce understanding of inheritance

risks and the importance of genotype testing before marriage.

 5. Collaborative Care Planning: Nurses should work in collaboration with physicians, social

workers, and health educators to design holistic care plans that incorporate both hospital-

based and home-based interventions tailored to each patient’s knowledge and capability

level.

6. Community Outreach and Advocacy: Nurses can play a pivotal role in outreach programs

to extend SCD awareness beyond hospital settings—into schools, churches, and

communities—thus addressing knowledge disparities at a population level.

Limitations Based on the Findings

1. High Knowledge but Low Practice: Although the majority of respondents demonstrated

high knowledge about breast cancer screening (e.g., 93.3% understood early detection

improves treatment), this did not necessarily translate to high screening uptake,

suggesting a possible gap between knowledge and action that the study could not fully

explore.

2. Attitudinal Discrepancies: Despite 95% of respondents indicating a positive attitude, a

significant number (26.6%) still agreed that screening is unnecessary unless symptoms

appear, revealing underlying misconceptions that were not deeply analyzed.

3. Influence of Cultural Beliefs: The finding that 60% of respondents agreed cultural

beliefs hinder screening points to significant socio-cultural barriers. However, the study

did not qualitatively explore specific cultural norms or practices that might influence

these beliefs.

4. Limited Analysis of Fear as a Barrier: Fear of diagnosis was identified as a factor by

40% of respondents, yet the study did not explore the psychological roots or emotional

impact of this fear, which may be critical to improving screening behavior.

 5. Healthcare Provider Role: While 93.3% agreed that healthcare provider support

influences screening, the study did not assess the nature or frequency of such support

during antenatal visits, which limits understanding of how providers actually influence

decisions.

6. Homogeneity in Educational Background: With 83.3% of respondents having at least

secondary education, the sample may not adequately represent the views of less-educated

populations who might have very different knowledge and attitudes.

5.3 Limitations of Study

The researchers encountered small restrictions throughout the inquiry, as is common in all human

undertakings. The principal constraint was the scarcity of literature about knowledge, attitudes,

and practices regarding breast cancer screening among pregnant women attending antenatal

clinics at Lagos State University Teaching Hospital (LASUTH). Considerable effort and

organisation were required to acquire relevant resources, publications, or information throughout

the data collection process. The study is limited by a small sample size, concentrating only on

Lagos State University Teaching Hospital (LASUTH). As a result, the findings of this study

cannot be generalised, thereby requiring more investigation.

The researcher encountered time restrictions owing to the need of doing this investigation while

attending courses and meeting other educational commitments. Nonetheless, despite the

limitations encountered throughout the investigation, all factors were mitigated to get ideal

findings and guarantee the research's success.

5.4 Summary and Finding

This study was conducted to assess the knowledge, attitudes, and practices of breast cancer

screening among pregnant women attending antenatal clinics at LASUTH. The specific
objectives included assessing the level of knowledge about breast cancer screening among

pregnant women, evaluating their attitudes toward screening, identifying factors influencing their

screening behavior, and determining the relationship between demographic variables and

screening uptake. The study adopted a descriptive cross-sectional research design to obtain data

on the study population at a single point in time. The study population comprised pregnant

women attending LASUTH antenatal clinics, and a sample size of 152 was determined using

Cochran’s formula. The sampling technique used was simple random sampling, ensuring equal

chances for all participants. A structured questionnaire was the primary data collection method,

comprising sections on demographic details, knowledge, attitudes, and screening practices. To

ensure reliability, a test-retest technique was employed, and Spearman’s correlation was used for

validation. Data were analyzed using SPSS, with descriptive statistics (percentages and

frequencies) summarizing participant characteristics and inferential statistics such as logistic

regression used to determine associations between variables. Based on the analysis conducted,

below are the major findings:

1. Analysis of Research Question 1 showed that majority of respondents demonstrated strong

knowledge of breast cancer screening, with over 90% correctly identifying the importance of

early detection (Item 6: 93.3%; Item 7: 96.7%) and recognizing breast self-examination as a

key method (Item 4: 90%). However, 13.3%–26.7% still held misconceptions, such as

believing symptoms must appear before detection or that family history is necessary for

screening.

2. On research question 2, respondents showed a highly positive attitude, with over 90%

supporting screening when advised (Item 2: 93.4%) and acknowledging its importance (Item
 1: 93.3%). 90% also felt comfortable discussing it with providers. Yet, 26.6% still

incorrectly believed screening is unnecessary without symptoms.

3. On Research Question 3, the most influential factors identified were knowledge (93.4%),

provider support (93.3%), and accessibility/affordability (90%). Meanwhile, fear (40%) and

cultural beliefs (60%) had more mixed responses, indicating they moderately hinder

screening uptake.

5.5 Conclusions

The study highlights that while pregnant women at LASUTH exhibit a strong awareness of

breast cancer screening and a positive attitude towards its importance, actual uptake of screening

services remains suboptimal due to cultural beliefs, fear of diagnosis, and accessibility

challenges. The results confirm that education and knowledge levels play a significant role in

promoting screening behavior. Therefore, targeted interventions focusing on education,

affordability, and accessibility improvements are necessary to enhance breast cancer screening

rates among pregnant women. The findings emphasize the need for healthcare institutions and

policymakers to integrate breast cancer screening into routine antenatal care programs to

encourage participation and reduce mortality rates associated with late-stage detection.

5.6 Recommendations

Based on the findings, the following recommendations are made:

 Healthcare institutions should integrate breast cancer screening into routine antenatal care

services, ensuring that pregnant women receive regular information, guidance, and opportunities

for clinical breast examinations as part of their prenatal visits. This will enhance early detection

and improve outcomes.

 The government should implement subsidized or free breast cancer screening programs for

pregnant women, particularly in low-income communities, to reduce financial barriers and

encourage higher screening uptake. Financial incentives and insurance coverage for

mammograms and clinical breast examinations should also be prioritized.

 Community health education programs should be expanded to address cultural beliefs and fears

associated with breast cancer screening, using culturally sensitive approaches such as

engagement with community leaders, religious institutions, and local media to debunk myths and

promote screening.

 Healthcare professionals should receive regular training on patient-centered approaches to breast

cancer screening counseling, ensuring that they effectively communicate the importance of

screening, address patient concerns empathetically, and provide practical guidance on self-

examinations and clinical screenings.

5.7 Suggestions for Further Research

Future research should focus on evaluating the effectiveness of community-based breast cancer

screening interventions tailored for pregnant women, particularly in rural areas where access to

healthcare services may be limited. Additionally, further studies should explore the impact of

integrating breast cancer screening education into routine antenatal programs across multiple

healthcare facilities to assess the long-term effects on screening uptake and early detection rates.

Finally, qualitative research on the personal experiences of pregnant women regarding breast

cancer screening could provide deeper insights into socio-cultural barriers and inform targeted

intervention strategies.

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