Promoting Early Diagnosis of Breast Cancer in Nigeria Using Materials Designed to Cross Communication Barriers of Fear, Taboo and Literacy Between Health Care Teams and the Community at Risk From Breast Cancer

Abstract

Background: Nigeria, annually, has the highest numbers of death from breast cancer (BC) in Africa, estimated at 10,000. While BC incidence is declining in many parts of the world, it is increasing in Nigeria. Delay in BC diagnosis in Nigeria is due to: i) health care professionals (HCPs) and patients having poor knowledge of BC causation and symptoms; ii) incorrect diagnosis of symptoms; iii) delay in treatment seeking; iv) use of ineffective/harmful treatment methods.1 Low literacy rates, fear of cancer and the cultural taboos associated with BC create communication hurdles difficult to overcome.2 Aim: Increased HCP and patient of knowledge of BC causes, symptoms and detection, and improved communication between HCP and patients, resulting in increased and improved diagnostic protocol adherence, more patients self-reporting symptoms, and ultimately down-staging of patients. Methods: i) Aggregation of historical data of participating clinics of patients BC stage at diagnosis; ii) survey of HCP knowledge of BC symptoms and diagnostic protocols before and after seeing Worldwide Breast Cancer´s (WBC) Know Your Lemons (KYL) education materials; iii) frequency of display of KYL posters in clinics; iv) HCP survey of frequency of BC health discussions during a clinic visit; v) pre- and postsurvey of patient knowledge, interest and willingness to report symptoms at community education sessions, vi) count of number of patients reporting symptoms while making/attending clinic appointments. Results: Increase in HCP knowledge of symptoms and diagnostic protocols before and after seeing the KYL education materials; more visible use of patient friendly BC education materials displayed in the clinic; increase in frequency of breast health discussions initiated by HCPs with their patients; improved patient interest and knowledge of symptoms and diagnostic protocols; increase in patient confidence in being able to recognize a BC symptom; increase in patients making clinic appointments and self-referring symptoms to HCPs. Conclusion: As proven in other parts of the world with the KYL education materials, the researchers aim to prove, in undertaking this study in Lagos, Nigeria, that training HCPs (e.g., patient navigators, community workers, primary care physicians, mammography technicians) and patients in the signs/symptoms and risk factors for breast cancer using WBC´s bright, appealing and eye catching KYL materials can improve how HCPs and patients communicate about BC symptoms and detection option, which leads to earlier stage of diagnosis. 1. Agba et al, 2012; American Cancer Society, 2011; Cancer Today, 2012; Ogundipe, 2011; Osain, 2011; Prevalence of Breast Cancer, 2015. 2. Okpara and Kabongo, 2011; Total Facts Nigeria, 2017; World Atlas, 2017.