Abstract A24: Evaluation of a breast cancer screening program in Nigeria
Authors: Elewonibi Bilikisu Reni 
Published: May 2016

Abstract
Background: Late stage diagnosis has been cited as the biggest cause of breast cancer mortality in Nigeria. Low levels of breast cancer awareness among Nigerian women decrease the likelihood they undergo screening; therefore, cancer is often diagnosed at late stages. The Optimal Cancer Care Foundation (OCCF) was founded to address the issue of low breast cancer screening and awareness in Lagos, Nigeria. OCCF provides subsidized screening without long waiting periods or crowds associated with public hospitals. OCCF also conducts weekly seminars on risk factors, signs and symptoms associated with breast cancer. Ongoing assessment of program implementation and effectiveness is necessary for OCCF to provide the maximum benefit. This study aims to describe culturally relevant factors from patient interviews that may be influential and deserve consideration in the OCCF breast cancer screening program and perform an evaluability assessment in partnership with the OCCF to determine if the program is achieving its stated objectives and to adjust OCCF activities to improve outcomes.
Methods: The study took place in the screening facility of OCCF in Lagos, Nigeria in June and July 2015. The eligibility criteria were women 18 years and older, able to speak English and not pregnant. An incentive was provided in the form of clinic registration fee, 500 naira or $3 for new patients or soap and tooth paste worth the same amount for women who had already registered at the clinic. Program participants were given a survey to determine baseline breast cancer knowledge, at which time demographic data was also collected. Semi-structured interviews to assess screening beliefs were also conducted. Descriptive statistics were employed to assess sample demographics. Content analysis was conducted to assess responses for semi-structured survey questions.
Preliminary Results: All patients present on interview days filled the survey. 129 women, with an average age of 37 and a range of 18-61 answered the survey. Sixty four percent of the participants were new patients. Fifty-two percent of the sample had a college or graduate degree while 23% of women had a high school education or less. Twenty-two percentage had technical or vocation training certificates. Sixty-five percent of women were married and 2% were widows. Twenty-two percent of women were currently unemployed. Thirty-two percent of women were self-employed while 33% had some other professional employment. Forty-three percent of women did not know their risk of getting breast cancer. Thirty-three percent believed that breast cancer was a disease only common in the elderly while 66% believed that breast cancer could be inherited. Five percent believed that breast cancer was caused by evil spirits while 12 % were not sure if breast cancer could be caused by evil spirits. Finally 50% of women had never been screened for breast cancer prior to coming into OCCF. Ninety-four interviews were conducted. Screening barriers included cost of screening and transportation to OCCF, lack of awareness and knowledge about the program and breast cancer and fear associated with stigma of being diagnosed with breast cancer. Many women stated that religion and traditions may play a part in predicting if a women gets screened. It was believed by some that getting screened was an avenue to invite disease into the body. Many believed that breast cancer is caused by evil spirits, curses, or being promiscuous. Others believed that eating canned food, using a microwave, putting money in the bra or wearing a bra caused breast cancer. All women interviewed believed it was important for women for talk to each other about breast cancer but many did not believe it was important to involve men in the discussion.
Conclusion: Interventions that increase women's breast cancer knowledge and change negative beliefs associated with decreased screening would lead to improved screening rates in this population.
Citation Format: Bilikisu Reni Elewonibi. Evaluation of a breast cancer screening program in Nigeria. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A24.