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Product Category: Projects

Product Code: 00005957

No of Pages: 75

No of Chapters: 1 - 5

File Format: Microsoft Word

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TITLE PAGE -           -           -           -           -           -           -           -           -           i

COVER PAGE                      -           -           -           -           -           -           -           ii

CERTIFICATION                 -           -           -           -           -           -           -           iii

DEDICATION                       -           -           -           -           -           -           -           iv

ACKNOWLEDGEMENTS               -           -           -           -           -           -           v

LIST OF TABLES     -           -           -           -           -           -           -         -             viii

ABSTRACT   -           -           -           -           -           -           -           -           -           ix



Background to the Study     -           -           -           -           -           -           -           1

Statement of the Problems   -           -           -           -           -           -           -           10

Purpose of the Study -           -           -           -           -           -           -           -           11

Research Questions   -           -           -           -           -           -           -           -           11

Significance of the Study      -          -           -           -           -           -           -           12

Scope of the Study    -           -           -           -           -           -           -           -           13

Limitation of the Study          -           -           -           -           -           -           -           13

Definition of Terms                -           -           -           -           -           -           -           13





Conceptual Framework           -           -           -           -           -           -           -           15

Concept of breast cancer        -           -           -           -           -           -           -           15

Concept of breast self examination-               -           -           -           -           -           17

Knowledge, attitude and practice of breast self examination            -           -           19

Theoretical Framework           -           -           -           -           -           -           -           20

Empirical Studies        -           -           -           -           -           -           -           -           25

Summary of Reviewed Literature      -           -           -           -           -           -           32



Design of the Study    -           -           -           -           -           -           -           -           36

Research Population               -           -           -           -           -           -           -           36

Sample and Sampling Techniques      -           -           -           -           -           -           36

Instrument of the study          -           -           -           -           -           -           -           37

Validity of the Instrument      -           -           -           -           -           -           -           38

Reliability of the Instrument -            -           -           -           -           -           -           39

Methods of Data Collection   -           -           -           -           -           -           -           39

Methods of Data Analysis      -           -           -           -           -           -           -           39




Data Analysis  -           -           -           -           -           -           -           -           -           40

Discussion of the Major Findings-      -           -           -           -           -           -           49



Summary         -           -           -           -           -           -           -           -           -           51

Conclusion      -           -           -           -           -           -           -           -           -           53

Recommendations      -           -           -           -           -           -           -           -           54

REFERENCE -        -           -           -           -           -           -           -           -           55

APPENDIX I -           -           -           -           -           -           -           -           -           62

APPENDIX II-          -           -           -           -           -           -           -           -           63








Breast self examination is a monthly examination a woman can perform by herself to check for breast cancer, breast self examination is cheap and not painful; however it is dependent on the knowledge and attitude of women and young girls towards it. This study was carried out to assess the knowledge of breast self examination among female students in Ambrose Alli University, Ekpoma, Edo State.  A sample size of one hundred and ninety students was drawn from the population of the study. A questionnaire was developed and used for collection of data. The data was analysed using frequency counts and percentages.  The findings revealed that there is a high level of awareness of breast cancer and breast self examination among the students, the knowledge of BSE is inadequate among the students and the knowledge of the symptoms of breast cancer to watch out for during Breast Self Examination is also inadequate. It was recommended among other things that curriculum planners should include the teaching of breast self examination in senior secondary school, health education curriculum in the universities, Non-Governmental Organization (NGOs); Health personnel should be organizing health outreach to sensitize young girls and women in every community on breast self examination in order to prevent breast cancer and health personnel should be equipped with more knowledge on early detection of breast cancer and practices of breast self examination. Seminars should be organised for nurses on breast self examination at the federal and state level. Creating public awareness and enlighten scheme on breast self examination should also be encouraged through social media.







1.1       Background to the Study

Worldwide, breast cancer is the second most frequent cancer and the fifth cause of cancer-related mortality. It is the most common cancer to affect women and it is second only to lung cancer as the principal cause of cancer-related deaths among women (Pisani, Bray and Parkin 2002). In low- and middle-income countries (LMICs), it remains a significant public health challenge as incidence rates have been shown to increase yearly by as much as 5% with over 1 million projected new cases annually by 2020 (Thomas, 2006). The emergence of breast disease and subsequent development of cancer appears to be more aggressive in young women compared to its progression in older women (Adebamowo and Ajayi, 2000). In 2008, the prevalence of breast cancer in women ≥15 years in sub-Saharan Africa was estimated at 23.5 per 100,000 women and approximately 35,427 women died from the disease (crude mortality rate of 12.8 per 100.000 women).

In Nigeria the incidence of breast cancer is higher than the worlds average; estimated at 2625 per 100,000 women with a resultant high mortality. The high morbidity and mortality due to breast cancer can be in-part reduced if the lesion is detected early enough. In this regard, women need to be "breast aware" by being able to identify the risk factors and symptoms of breast cancer as well as risk reduction strategies (Isara and Ojedokun, 2011).

Breast cancer is one of the most prevalent cancers in the world among women. It is considered as the world's leading cause of cancer deaths among women. Today studies have shown that one in every eight women is likely to develop breast cancer at some point in their life Although breast cancer usually develops in after the age of 45, the age range has rapidly decreased and younger women in their early 20s are beginning to develop the disease. Cancer in younger women is generally more aggressive and can result in low survival rates making early detection to be very important.

Breast cancer has increasingly become an issue of public health importance. In the year 2000, there were 10 million new cases of cancer and 6 million cancer deaths worldwide. Each year, in the United States, almost 1.5 million individuals learn that they have some form of cancer. Breast cancer is by far the most commonly diagnosed cancer in women, and, in the US in 2007, 202,964 women were diagnosed with breast cancer and 40,598 died from the disease. Its incidence is becoming more common worldwide. Studies have shown an increased incidence from African countries, where low rates have previously been reported, and an estimated world total incidence of 1.45 million was expected by the year 2010. It is estimated that a woman who lives to the age of 90 years has a one in eight chance of developing breast cancer. The peak age incidence of breast cancer in Nigeria is reported to be between 45 and 50 years, in contrast to Europe and America, where it was reported to be 65-75 years. Some cases have been reported below 30 years in Nigeria.  Breast cancer reduces the life expectancy of the population at risk, especially those between 31 and 50 years.

Breast cancer is characterised by the uncontrolled growth of abnormal cells in the milk producing glands of the breast or in the passages (ducts) that deliver milk to the nipples; breast cancer is the most common cancer and the leading cause of cancer death for women which accounts for 23% of all female cancers globally. Worldwide, an estimated 1.7 million women were diagnosed with breast cancer and about 522,000 women died from breast cancer in 2012. Between 2008 and 2012, breast cancer incidence rate has increased by more than 20%, while mortality has increased by 14%. Breast cancer is also a leading cause of cancer death in the less developed countries of the world (International Agency for Research on Cancer (IARC), 2013). For women aged 15–49 years, twice as many breast cancer cases are diagnosed in developing countries than in developed countries (Forouzanfar, Foreman and Delossantos et al., 2010).

In low-resource settings, 7 out of 10 people newly diagnosed with breast cancer die while 2 out of 10 die in high-resource settings. In Ethiopia, breast cancer is the first leading cancer among females with 24.4% prevalence rate. In 2014, 12,956 women were diagnosed with breast cancer and 26,200 women died by breast cancer (World Health Organization, 2014); breast cancer is a public health problem. It attacks women in their most productive years of life but breast cancer can be cured with limited resources if detected early, but treating advanced stage disease is expensive and outcome is often poor (Unkels and Kantelhardt, 2011).

The most important strategies for achieving early detection of breast cancer are mammography and physical examination of the breasts by a physician or qualified health worker through clinical breast examination (CBE) and breast self-examination (BSE). Breast self-examination is a process whereby women examine their breasts regularly to detect any abnormal swelling or lumps in order to seek prompt medical attention (Kayode and Akande, 2005). While mammography helps to detect breast cancer before women feel a lump, breast self-examination also helps women to be familiar with how their breast look and feel so they can alert their health care professionals if there is any change. Johns Hopkins Medical center states, “Forty percent of diagnosed breast cancers are detected by women who feel a lump, so establishing a regular breast self-examination is very important” (National Breast Cancer Foundation PLC).

Breast self-examination, carried out once monthly, between the 3rd  and 5th  day after the menstrual cycle, goes a long way in detecting breast cancer at the early stages of growth when there is low risk of spread, ensuring a better prognosis when treated (Kayode and Akande, 2005). Early diagnosis has a positive eect on the prognosis and limits the development of complications and disability. Furthermore, it increases life quality and survival (Muhammed, 2014). As many studies indicated the practices of Breast self-examination, are low among university students. A study conducted in Cameroon among female undergraduate students in the University of Buea indicated that only 9.0% knew how to perform BSE, only 13.9% knew what to look for while performing BSE, and only 3% had performed BSE regularly. Furthermore, Lack of knowledge on BSE was cited as the main reason for not performing (Nade et al., 2015).

Similarly, another study conducted in Nigeria has also shown that only 19.0% of the study participants were performing breast self examination monthly (Gwarzo, Sabitu, and Idris, 2009). Limited knowledge about the realities so breast cancer and lack of knowledge about the importance of self-examination and how it is performed are the main barriers for not practicing BSE. However, the magnitude practices of BSE are limited in our country, particularly in the study area. The high incidence and fatality rate of breast cancer as well as the high cost of treatment require that it should be of a focus of high attention for health authorities and policy makers.

The knowledge and care-seeking attitude for breast cancer management is so low that majority of the affected patients present late in the hospital when little or nothing can be done again. Studies have shown that most patients with breast cancer in developing countries like Nigeria present for the first time at stages 2 and 3. This indicates a need for increased community awareness of methods for early detection of the disease. Although breast cancer cannot be prevented, the risks of developing breast cancer can be minimized. Diagnosis of breast cancer during the early stage of the disease has been positively linked to a decrease in mortality, morbidity and effective cost of management of the illness. There are various methods of early detection of breast cancer. These include: Breast self examination (BSE), clinical breast examination (CBE) and mammography screening.

Breast Self Examination involves visualization and palpation of the breast by oneself for lumps, shape, texture, size and contour. The purpose of this is for a woman to learn the topography of her breasts, know how her normal breasts feel and be able to identify changes in them should they occur in the future. Studies have shown that BSE has a positive effect on the early detection of breast cancer. Despite that, there is no scientific evidence supporting the role of BSE in the early detection of breast cancer, and some authors have argued that the declining practice of BSE dramatically decreases the probability of early detection of breast cancer. 

The recommendations by the American College of Obstetricians and Gynaecologist (ACOG) and the American Cancer Society are for breast self examination to be performed monthly beginning at the age of 20 years and clinical breast examination annually beginning at the age of 18 years. Although the role of regular breast self examination has been debated, recent studies have suggested that breast self examination is a reliable screening tool when used as an adjunct to clinical breast examinations and imaging study. Again, it can nevertheless be utilized in enhancing breast cancer awareness among women. In fact, regular breast self examination  has been suggested as part of an overall health promotion concept. It is important therefore to adequately motivate women to regularly carry out breast self examination so as to curtail the increasing mortality rate from breast cancer (Montazeri et al., 2008).

Most of the deaths from breast cancer are accounted for in developing countries due to lack of early detection programs, lack of adequate diagnosis and treatment facilities. This deficiency has led to many women presenting the disease in the late stages which provides very few chances of survival. The two components of early detection of breast cancer are health education to promote early diagnosis and screening (Isara and Ojedokun, 2011). Early diagnosis makes women to have more treatment options and a chance of long term survival. This can be done with the use of breast self examination (BSE), clinical breast self examination (CBE) and mammogram. In developing countries, BSE is seen to be a simple inexpensive, non-invasive and non-hazardous intervention that also encourage women to take responsibility for their health (Narimah 1999).

Breast cancer (BC) is the most common cancer type and cause of death among women in many countries. Meanwhile, the early discovery of breast lumps through breast self-examination (BSE) is important for the prevention and early detection of this disease. Early detection of BC by population-based screening programs would be a potentially useful approach for controlling the disease and reducing mortality. 4 Periodical mammograms, clinical breast examinations (CBE), and monthly BSE, are crucial to detect BC at an early stage.  In some countries, although the early detection of BC can increase the survival rate, there has not been any systematic approach to increase the awareness of BC. Therefore, many women miss early detection and treatment opportunities due to lack of information, knowledge, and awareness of BC, as well as cancer screening practices. In other countries, the cost of screening mammography is considered to be high and policy makers are considering implementing screening programs based on CBE rather than mammography. CBE is a simple, very low cost, non-invasive adjuvant screening method for the detection of early BC in women. Its purpose is important in the case of a prompt reporting of breast symptoms which are important early detection messages for women of all ages, and to make women familiar with both the appearance and the feel of their breasts as early as possible (Salaudeen et al., 2009).

Although opinions conflict about the value of breast self examination, there is no uniform agreement for breast screening. Breast self examination is an important screening measure for detecting breast cancer. There is evidence that women who correctly practice breast self examination monthly are more likely to detect a lump in the early stage of its development, and early diagnosis has been reported to influences early treatment, to yield a better survival rate. Despite the benefits associated with breast self examination, few women regularly perform it and many do not even know how to perform it. There is also evidence that women are more likely to perform breast self examination effectively when taught by physicians or a nurse (Salaudeen, Akande and Musa, 2009).

The practice of breast self examination has been suggested as part of the health promotion strategies that can help women and young girls to be familiar with their breast, its structure and how their normal breast should feel like, thereby increasing their sensitivity to detect any abnormalities in their breast. Breast self examination is cheap and not painful; however it is dependent on the knowledge and attitude of women and young girls towards it. 

Adolescence is a transition period between childhood and adulthood and during this period significant changes occur in the body.  Studies in Nigeria have shown that women and young girls have poor knowledge of breast cancer and its risk factors (Salaudeen et al., 2009). The adolescence period is a time that provides teaching opportunities for shaping health behaviors into adulthood. Most of the fresh undergraduate students are adolescents that need to be taught the importance of breast self examination and how to practice it in order to encourage positive behaviors towards BSE and seeking professional help when needed. 

Although a lot has been done on the awareness and practice of breast self examination, not much has been done among the relatively less-educated group, like women that work in the market, as most of the studies have been directed toward relatively more educated and privileged group like nurses, doctors, university students, school teachers, amongst others.

1.2       Statement of Problem

Breast cancer which is an increasing cause of death amongst women around the world can be detected early enough through regular breast self examination. Despite the measures put in place to detect the disease at the early stage, the prevalence and late detection of breast cancer is still on the increase as a result of lack of breast self examination.

 The practice of breast self examination has been suggested as part of the health promotion strategies that can help women and young girls to be familiar with their breast, its structure and how their normal breast should feel like, thereby increasing their sensitivity to detect any abnormalities in their breast. Breast self examination is cheap and not painful; however it is dependent on the knowledge and attitude of young ladies towards it. 

Therefore, need to find out the attitude and practice of breast self examination among female health education students in Ambrose Alli University, Ekpoma, Edo State.


1.3       Purpose of the Study 

The purpose of this study therefore is to examine the attitude and practice of breast self examination among female health education students in Ambrose Alli University, Ekpoma, Edo State.

The specific objects of this study are:

1.      To find out if the undergraduate female health education students know anything about breast cancer,

2.      To determine the attitudes and practice on breast self-examination among female health education students in Ambrose Alli University, Ekpoma, Edo State, and

3.      To find the level of knowledge on breast self-examination among female health education students in Ambrose Alli University, Ekpoma, Edo State.

1.4       Research questions

1.      Does the undergraduate female health education students know anything about breast cancer?

2.      What are the attitudes and practices of the female health education students towards breast self-examination in Ambrose Alli University, Ekpoma, Edo State?

3.      What is the level of knowledge on breast self-examination among selected female health education students in Ambrose Alli University, Ekpoma, Edo State?

1.5       Significance of the Study

This study would help students, health worker, lecturers, and the society after completions.

The undergraduate female health education students would be benefiting from this study findings after completion. It would enable practice breast self examination frequently because of the relevant of the exercise also exposes them to clinical examination as well.

The findings of this study would enable female health education students to carryout orientation with their family members on the need to practice breast self examination in other to detect early care for cancer.

The findings of this research work would serves as empirical for future research work, it would help lecturers to know the areas in which these problems occur mostly and frequently and then improve their teaching strategies. It would help health education lecturers to device health education materials and manuals that would improve the teaching strategies for practice of breast self examination.

The blue print of this research work would serve as a reminder for the primary health worker in Edo state. The findings of the study would help NGOs and community on the awareness of breast self examination.

1.6       Scope of the Study

This study was limited to the female undergraduate health education students of Ambrose Alli University, Ekpoma Edo State. Where the researcher is familiar with the environment and is likely to gain access to the population to be studied.


1.7       Limitations of the Study

It was difficult to make generalization from the findings of the study because of the sample size, as the researcher was not able to utilize all members of the population of study.

1.8       Definition of Terms

Breast cancer: It is an uncontrolled growth of breast cells that forms a tumor in the breast.

Breast self-examination: Monthly examination of breasts conducted by women following the five major steps of breast self-examination which include: examining both the breasts for size, shape, color and contour while looking in front of the mirror with their arms straight, on the hips, and over the head; to palpate or feel the breast both in standing and lying position using the three finger pads.

Knowledge: It means the facts/condition of knowing something with familiarity gained through experience or association.

The practice of breast self examination: has been suggested as part of the health promotion strategies that can help women and young girls to be familiar with their breast, its structure and how their normal breast should feel like, thereby increasing their sensitivity to detect any abnormalities in their breast.

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