Willingness to accept preventive bilateral mastectomy among women in rural and urban communities in South-Western Nigeria

Abstract

Background: Breast cancer is the commonest cancer in women with highest mortality in developing countries due to late presentation. The decision to remove both breasts through preventive bilateral mastectomy among high risk individuals in developing countries would transcend social, cultural and even spiritual boundaries. Preventive mastectomy if considered among women at high risk, can significantly reduces the life time risk of developing breast cancer. The study compared willingness to accept preventive bilateral mastectomy among women who reside in urban and rural communities in South-West Nigeria. Methods: Both quantitative and qualitative methods were employed. The quantitative study was a cross-sectional comparative survey among 680 women aged 20 years and above selected using a multi-stage sampling technique from two predominantly rural and urban Local Government Areas. Participants were interviewed using semi-structured, interviewer-administered questionnaires. In the qualitative study, focus group discussion sessions were held with the women in both rural and urban areas and analysed using detailed content analysis and results presented with Z-Y tables. Quantitative data were analysed using SPSS software version 16.0. Results: Results showed that One hundred and sixty seven (49.1%) and 132 (38.8%) of women in urban and rural areas respectively were willing to accept preventive bilateral mastectomy as a primary prevention strategy if they are identified to be at high risk. (χ 2 =7.3, P = 0.007). For those who were unwilling to accept preventive bilateral mastectomy as an option for breast cancer prevention, the commonest reasons were cosmetic-related (disfigurement and scars). The determinants of willingness to accept preventive bilateral mastectomy among women in rural areas were: self-perceived risk in urban areas and level of education (P = 0.035). Respondents at high self-perceived risk of breast cancer in rural areas were 1.94 times more likely to accept preventive bilateral mastectomy compared with those at average self-perceived risk (OR 1.94, CI 1.22-3.08). Conclusions: The study concluded that respondents with increased knowledge of breast cancer, high level of educational attainment and high self-perceived risk of breast cancer were more likely to accept preventive bilateral mastectomy as a primary prevention strategy if found to be at high risk for developing breast cancer.