Breast cancer represents a real public health problem due to its increasing frequency, its seriousness and its psycho-social implications. It is the first cancer in women worldwide [1]. It is estimated that there were 14.1 million new cases and 8.2 million deaths from breast cancer in 2012 [2].

In sub-Saharan Africa, breast cancer is the second most common cancer after cervical cancer in women [3]. It seems to be more common during the period of genital activity between 35 and 45 years, i.e. 10 years earlier than in developed countries [3]. In Togo, the incidence of breast cancer is particularly high (17.09%) [4]. It accounts for 15.8% of cancers in older women and ranks second among cancers in women after cervical cancer (16.2%) [5].

Faced with this public health issue and in order to lower the mortality rate, developed countries have set up an organized screening program, making it possible to make the diagnosis as soon as possible. Indeed, breast cancer can be cured in 90% of cases when it is detected at an early stage [6]. The screening is done by clinical examination, and especially by mammography. In Togo a study by Agoda-Koussema et al. [7] in 2010 reported a sensitivity of 71.74% and a specificity of 89.65% in the diagnosis of breast lesions. However, in developing countries, no organized mammographic screening program has been established. Thus, each woman must manage to get an individual screening provided she is informed.

In addition, few studies have so far established the level of awareness of women on mammographic screening for breast cancer in Togo. The aim of this work was therefore to determine the level of awareness of women regarding mammographic screening for breast cancer in Togo.

Our study was prospective and concerned women with no current breast pathology, who had never undergone mammography, who came for consultation and who had voluntarily agreed to participate in this study. This study has some limitations related to the selection bias of the population studied, the independent nature of each investigator which could influence the results and the number of women who participated in the survey. However, our study remains representative.

Our study focused on women over 30 years of age. Kiguli et al. [8] had considered the same age limit. Similar studies by Opoku et al. [9] and Donnelly et al. [10] focused on women aged above 35 and 40 years respectively. The choice of the age threshold is motivated by the age from which breast cancer would be more frequent and the age from which mammography would be more indicated. The mean age of our sample was 42.96 years. This age can be matched with those obtained by Donelly et al. [10] (44.9 years), and by Obajimi et al. [11] (40.2 years).

Our sample as well as that of Morse et al. [12] (44.1%) was dominated by female traders. On the other hand, in the studies by Kiguli et al. [8] and Donnelly et al. [10], civil servants predominated with 43% and 34.1% respectively. The majority of women in our study (75.9%) were educated. The same is true in the studies by Kiguli et al. [8] (77%) and Obajimi et al. [11] (80%). Women with a university education were poorly represented in our study (12.4%), unlike the series by Donelly et al. [10] (33.3%) and Obajimi et al. [11] (31.8%).

Awareness of breast cancer is essential to allow its early diagnosis. In our study, 88.8% of women had some knowledge about breast cancer. This figure, although high, is lower than those found by Yusof et al. [13] (99.1%) and by Morse et al. [12] (98.2%). Awareness of breast cancer was not directly correlated with awareness of mammography. Although the latter is not a new screening method, the level of awareness and its use in screening in most developing countries is quite poor [14]. In Togo, women who had some knowledge about mammography accounted for only 20.8%. This rate, as low as it is, is higher than that of Obajimi et al. [11] (5%). On the other hand, Kiguli et al. [8], as well as Akinola et al. [15] found higher rates, respectively 29% and 40.5%. This proves that in general, more than half of women had no information about mammography. The lack of information among women about mammography in African countries can be explained by insufficient mammography services. In several countries in sub-Saharan Africa, mammography can only be performed in hospitals in the capital, leaving the majority of women and even health workers in rural areas less informed about mammography.

Older women are less informed about mammography, as revealed in our study and that of Obajimi et al. [11], although mammographic screening for breast cancer is most indicated for them. Indeed, the women most likely to benefit from mammography are those whose age is between 50 and 69 years, because of the low breast density and the high frequency of breast cancer in this age group [9].

The low level of education of majority of women is another reason for the lack of information, since women do not know how to access precise information on breast cancer, especially since knowledge of mammography would be related to women’s level of education. Thus, better educated women would be better informed than less educated women regardless of age [8]. In our study, out of the women who had heard of mammography, 37.74% had a university education. The same results were reported by Obajimi et al. [11] and Akinola et al. [15].

There is also a relation between the level of information and the profession. Akinola et al. [15] reported an awareness level of 40.5% among healthcare workers. In our study, 63% of civil servants had knowledge of mammography.

Overall, the level of information about breast cancer diagnostics, especially mammography, is clearly very low. In our study, 83.3% of women found the information about mammography screening for breast cancer unsatisfactory. There are few sources of information, education and communication about the various diseases in general and breast cancer in particular. The main source of information in our study was midwives (37.2%) followed by mass media (36.2%). Indeed, prenatal consultations would represent a real opportunity to inform women about breast cancer and the means of screening. This explains the fact that midwives were the main source of information in our study. Physicians represented only 9.4% of information sources in our study, compared to 24.4% in the study by Donnelly et al. [10]. This is in contrast with the result of a study in the Western world, which found that 92% of women were informed by doctors [16]. In Africa, the lack of information from medical personnel is said to be partly filled by the mass media. Thus, the mass media are also an important source of information as demonstrated in our study, as well as those of Obajimi et al. [11], and Opoku et al. [9]. This is explained by the fact that in most African countries the media, especially local radio stations, are very accessible.

In conclusion, breast cancer remains a public health concern. It requires early detection for effective management. This study shows that there is a lack of information for women about mammographic screening, which is almost absent in sub-Saharan countries. The level of information of women on mammographic screening for breast cancer would be related to age, occupation and level of education. The implementation of strategies, involving all stakeholders to increase the level of information on mammographic screening for breast cancer, would reduce the death rates related to this cancer.

The authors thank the authorities and the health professionals of campus tcheatching Hospital and surrounding health facilities for their help in data collection and all the participants.

The authors declare no conflicts of interest regarding the publication of this paper.

Amadou, A., Nabede, S., Gbande, P., Dagbe, M., Sonhaye, L., Agoda-Koussema, L.K. and Adjenou, K. (2021) Women’s Awareness of Mammographic Screening for Breast Cancer in Togo. Journal of Cancer Therapy, 12, 655-662. https://doi.org/10.4236/jct.2021.1212057