Profile of Women With Breast Disorders in Pregnancy and Lactation and Additional Investigation Uptake

Abstract

Purpose The increasing incidence of breast cancer during pregnancy and postpartum in Nigeria remains a source of concern and management dilemma. Integrating a screening program into existing antenatal and postnatal services might provide a real opportunity to promptly detect and plan treatment in low-income countries. The objective of this work was to describe the profile of women referred for additional investigation after clinical breast examination (CBE) in pregnancy and during lactation and to identify factors that might influence uptake. Methods We used an explanatory sequential mixed-methods approach. A cross-sectional survey described 206 women who were referred for free breast ultrasound scan (BUS) after CBE at recruitment, in the third trimester, and at 6 weeks and 6 months postpartum in three different public health centers in Ibadan, Nigeria. We conducted 16 in-depth interviews (IDIs) to explore reasons for their decisions on BUS. Quantitative data were summarized and multiple logistic regression was performed to determine the association between explanatory variables and BUS uptake at P < .05. IDIs were transcribed and analyzed using a thematic approach. Results Mean age of participants was 28.5 ± 5.14 years. The majority of participants (61.7%) presented for BUS. Study participants were mostly recruited from secondary health facilities (71.8%), had less than a higher national diploma education (76.7%), and were of the Yoruba ethnic group (94.7%). History of breast self-examination practice was reported by 52 participants (25.24%) and 20 (9.71%) had ever performed CBE. Women with a higher national diploma level of education or greater were more likely to have undergone BUS (adjusted odds ratio, 4.41; 95% CI, 1.13 to 17.31). Reasons mentioned during IDI for avoiding BUS were financial constraint for breast cancer treatment and management after diagnosis, fear of an unfavorable BUS report, psychological wellbeing after breast cancer diagnosis, lack of trust in the health system, lack of information on BUS, and an assumption of none or less aggressive symptoms. Most of the women interviewed (93.8%) informed their husbands about the BUS referrals and they all received support. Conclusion The majority of participants who were educated presented for BUS. Some women declined additional evaluation of their breasts for fear of financial constraints, breast cancer diagnosis, and unknown fear of psychological implications. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.