1.1 Background to the Study
Breast cancer is the most common malignancy and first cause of cancer mortality in women worldwide with a world number of new cases estimated at 1,384,155 in 2008. Its worldwide prevalence is still on the rise[2, 3] and nowadays breast cancer is considered to be an increasing public health problem among populations in low- and middle-income countries (LMICs). Moreover, a recent population-based study of cancer survival in Africa, Asia and Central America found unacceptably low breast cancer survival rates in African countries especially in Gambia where the 5-year age-standardized relative survival did not exceed 12%.
Globally, breast cancer has been identified as a leading cause of death globally (1,2). There are more than a million new cases of breast cancer resulting in about 875,000 deaths each year, with high mortality rates in developing countries (3). In Nigeria, breast cancer has been reported to account for 56.6% of all cancer diagnosis between 1995&2002 (4). The burden of the disease has been on the increase and affected women often present late in hospitals when it has reached advance stage (5). Its cure at this stage becomes seriously compromised; the poor survival rate has been linked to late detection and diagnosis(6). Cancer is a disease process that begins when an abnormal cells is transformed by the genetic mutation of the cellular Deoxyribonuleic acids (DNA)(7). Breast cancer is neither painful nor cause any discomfort in its early stage. It usually present as a painless breast lump. There are diverse risk factors that may affect each woman’s susceptibility to the disease(3).
Besides poverty, low public awareness of breast cancer is a barrier to breast cancer control in LMICs where women seek medical help late and cancers are often diagnosed at advanced stages when very little can be done in terms of curative treatment. The Breast Health Global Initiative (BHGI) panel[5, 6] has recommended implementation strategies to optimize breast cancer management in LMICs concerning health-care systems, breast cancer diagnosis, treatment and early detection. For early detection, efforts must be devoted to improve community awareness. Civil society, represented by non-governmental organizations (NGOs), can play an important role in breast cancer control.
In Ghana, 2,062 new breast cancer cases and 1,137 breast cancer deaths were estimated annually (16.5% of all women cancer deaths), with age-standardized incidence and mortality rates of 25.8 and 15.2 per 100,000 women, respectively (Globocan 2008). Sixty percent of cases were detected at late stages (IIB, III and IV). The available data on median age are limited and mainly hospital based. Clegg-Lamptey et al. reported a median age at diagnosis of 43 years on a sample of 66 women newly diagnosed with breast cancer. The age range was broad, from 20 to 84 years. 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.