Determinants of Breast Cancer Screening Practices Among Women in Accra, Ghana

Background: Despite advancement in medicine and technology in preventing and controlling chronic diseases, breast cancer continues to claim many lives of women across the globe, especially in less industrialized countries such as Ghana.  The major goal of this study was to broaden women’s knowledge and understanding of breast cancer and screening practices.  The purposes were: (a) to assess Ghanaian women’s levels of breast cancer knowledge, beliefs, and screening practices; and (b) to explore factors that influence breast cancer screening practices among Ghanaian women.  The research questions were: (a) what were the levels of breast cancer knowledge and beliefs among Ghanaian women? (b) were women involved in BSE practice and mammogram screening? (c) which factors determined their breast cancer screening practices?

Methods: A cross-sectional survey design was used to collect data between October and December, 2008.  A convenience sampling method was used to recruit 194 women from two randomly churches in Accra, Ghana.  Ghana Health Service and Jackson State University Institutional Review Boards approved the study.  Permission and consent were sought from the churches and participants, respectively.  A structured self-administered questionnaire was used to collect data.  Measures used included selected sociodemographic information (age, occupation, and income), Champion’s Health Belief Model Scale (CHBMS), Breast Cancer Knowledge (BCK) test, and breast cancer screening practices questions.  Descriptive and inferential statistical methods including frequencies, chi-squared, and logistic regression were used to analyze data.

Results:  The mean age was 42 years (SD = 12.80), and ranged from 18 to 72 years.  About 66% of the participants reported a household monthly income below GHS500 (Ghana Cedi) (approximately US$400 in 2008).  Approximately 27% were traders, 26.8% were teachers and other civil servants, and 14% were nurses.  Nine percent identified themselves as self employed, and 11.3% were either unemployed, retired, or students.  Overall, the participants’ level of breast cancer and screening knowledge was moderate (63%), and they had low levels of perceptions of breast cancer and screening.  Seventy-one percent practiced breast self-examination (BSE) while 14% had mammogram screening.  Participants with higher knowledge were significantly more likely to practice BSE and/or to undergo mammogram screening.  Participants with lower levels of perceived barriers to BSE and perceived seriousness of breast cancer were more likely to practice BSE and/or mammogram screening compared with their counterparts with higher levels of perceived barriers and seriousness.  Perceived barriers to BSE, age, and occupation emerged as significant predictors of BSE practice, while physicians’ recommendation and income predicted mammogram screening.

Conclusion and Implications:  Overall, the findings suggest that breast cancer screening was low among the sample.  Intervention should target increasing breast cancer education and screening awareness among Ghanaian women.  Additionally, intervention programs should target Ghanaian women’s low levels of perceptions of breast cancer and screening.  Social workers should advocate for subsidized or free breast cancer screening services for low-income women.  Finally, physicians should encourage women who are eligible to undergo mammogram screening.