Willingness to accept preventive bilateral mastectomy among women in rural and urban communities in South-Western Nigeria
Keywords:Breast cancer, Preventive mastectomy, Rural and urban communities
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. (χ2 =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.
Hamilton R, Hurley KE. Conditions and consequences of a BRCA mutation in young, single women of childbearing age. Oncol Nurs Forum. 2010;37(5):627-34.
Barbas AS, Turley RS, Ceppa EP, Reddy SK, Blazer III DG, Clary BM, et al. Comparison of outcomes and the use of multimodality therapy in young and elderly people undergoing surgical resection of pancreatic cancer. J Am Geriatr Soc. 2012 Feb;60(2):344-50.
Hordern A. Intimacy and sexuality for the woman with breast cancer. Cancer Nurs. 2000;23(3):230.
Lavretsky H. Spirituality and aging. Aging Health. 2010;6(6):749-69.
Yanez B, Edmondson D, Stanton AL, Park CL, Kwan L, Ganz PA, et al. Facets of spirituality as predictors of adjustment to cancer: relative contributions of having faith and finding meaning. J Consult Clin Psychol. 2009;77(4):730.
Jenkins RA, Pargament KI. Religion and spirituality as resources for coping with cancer. J Psychosoc Oncol. 1995;13(1-2):51-74.
Jun EY, Choi SR, Kang HS. Experience of external breast prosthesis use among breast cancer survivors in Korea. Korean J Women Health Nurs. 2012 Mar;18(1):49-61.
Didier F, Radice D, Gandini S, Bedolis R, Rotmensz N, Maldifassi A, et al. Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality? Breast Cancer Res Treat. 2009;118(3):623-33.
den Heijer M, Seynaeve C, Timman R, Duivenvoorden HJ, Vanheusden K, Tilanus-Linthorst M, et al. Body image and psychological distress after prophylactic mastectomy and breast reconstruction in genetically predisposed women: a prospective long-term follow-up study. Eur J Cancer. 2012 Jun;48(9):1263-8.
Anderson BO. Prophylactic surgery to reduce breast cancer risk: a brief literature review. Breast J. 2001;7(5):321-30.
Kurian AW, Sigal BM, Plevritis SK. Survival analysis of cancer risk reduction strategies for BRCA1/2 mutation carriers. J Clin Oncol. 2010;28(2):222-31.
Griffin JL, Pearlman MD. Breast cancer screening in women at average risk and high risk. Obstet Gynecol. 2010;116(6):1410.
Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah M, Cronin WM, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998;90(18):1371-88.
Oluwatosin OA. Assessment of women's risk factors for breast cancer and predictors of the practice of breast examination in two rural areas near Ibadan, Nigeria. Cancer Epidemiol. 2010;34(4):425-8.
Hartmann LC, Schaid DJ, Woods JE, Crotty TP, Myers JL, Arnold P, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. New Engl J Med. 1999;340(2):77-84.
Metcalfe KA. Prophylactic bilateral mastectomy for breast cancer prevention. J Women’s Health. 2004;13(7):822-9.
Wagner T, Möslinger R, Langbauer G, Ahner R. Attitude towards prophylactic surgery and effects of genetic counselling in families with BRCAmutations. Br J Cancer. 2000;82(7):1249.
Haroun I, Graham T, Poll A, Sun P, Hill K, Weitzner E, et al. Reasons for risk-reducing mastectomy versus MRI-screening in a cohort of women at high hereditary risk of breast cancer. Breast. 2011;20(3):254-8.
Meiser B, Butow P, Friedlander M, Schnieden V, Gattas M, Kirk J, et al. Intention to undergo prophylactic bilateral mastectomy in women at increased risk of developing hereditary breast cancer. J Clin Oncol. 2000;18(11):2250-7.
Graves KD, Huerta E, Cullen J, Kaufman E, Sheppard V, Luta G, et al. Perceived risk of breast cancer among Latinas attending community clinics: risk comprehension and relationship with mammography adherence. Cancer Causes Control. 2008;19(10):1373-82.
Stefanek M, Enger C, Benkendorf J, Flamm Honig S, Lerman C. Bilateral prophylactic mastectomy decision making: a vignette study. Prev Med. 1999;29(3):216-21.
Metcalfe KA, Esplen MJ, Goel V, Narod SA. Psychosocial functioning in women who have undergone bilateral prophylactic mastectomy. Psycho‐Oncology. 2004;13(1):14-25.
Nelson JA, Tchou J, Domchek S, Sonnad SS, Serletti JM, Wu LC. Breast reconstruction in bilateral prophylactic mastectomy patients: factors that influence decision making. J Plast Reconstructr Aesthet Surg. 2012 Nov;65(11):1481-9.
Stefanek M, Hartmann L, Nelson W. Risk-reduction mastectomy: clinical issues and research needs. J Natl Cancer Inst. 2001;93(17):1297.
van Dijk S1, Otten W, Zoeteweij MW, Timmermans DR, van Asperen CJ, Breuning MH, et al. Genetic counselling and the intention to undergo prophylactic mastectomy: effects of a breast cancer risk assessment. Br J Cancer. 2003;88(11):1675-81.