<b>Introduction:</b> The level of knowledge and attitude of health professionals about breast cancer are important determinants. <b>General</b> <b>objective:</b> To study the knowledge, attitude and practice of health professionals of the hospital of the district of the commune IV on breast cancer. <b>Methodology:</b> This was a cross-sectional, prospective, descriptive, qualitative and quantitative study. The study period was from 01 October 2022 to December 2022. <b>Results:</b> In one week of survey, 110 health workers (intern, obstetrician nurse, general practitioners and specialists) received the survey sheet, 80 health workers informed it, a participation rate of 73%. The male sex was most represented at 63.75% with a sex ratio of 1.76. The average age was 39.59 years with extremes of 22 and 61 years. The clinical signs evoked by the participants were: breast nodule (81.25%), followed by breast discharge (48.75%). In relation to risk factors: interns and obstetrician nurses had no good knowledge, 51.72% of general practitioners had good knowledge, 43.48% of specialist doctors had good knowledge, and 5.88% of the wise had good knowledge. Conclusion: Breast cancer is a common pathology around the world, health professionals are at the forefront of the fight against breast cancer, and this fight cannot be effective without trained personnel.
The level of knowledge and attitudes of health care staff about breast cancer are important determinants that influence the adoption of screening methods by women in their communities [
The disparity in breast cancer incidence and mortality between developed and developing countries is due to different levels of knowledge about disease risk factors, access to effective treatment, and in particular the existence of early detection and detection program [
It is estimated that 70% - 90% of breast cancer cases are advanced in African countries, which is a cause of decreased survival probabilities among patients. [
Studies have shown that breast cancer screening programs through mammography, breast self-examination (AES) and clinical breast examination (ECS) play an important role in early detection, increase survival, decrease the number of deaths and prevent recurrence in breast cancer patients [
However, the adoption of these methods by women depends on several factors, such as religious beliefs and the attitude of health workers according to Mitchell J. [
Y. A. Sawadogo [
Among gynecologists/doctors, 95.5% of people reported prescribing mammography in case of suspicious breast lesions, 9 providers would prescribe it in case of presence of risk factors and 15 providers would systematically prescribe mammography in patients over 35 years of age.
A study conducted in Morocco by Haya Salam [
A study conducted by KOUAMO II Eitel Igor [
22.23% of gynecologists and 58% of general practitioners do not advise breast self-palpation during consultations.
It is very difficult to fight cancer effectively if health professionals do not have the right information, the right attitude and the right practice.
In our hospital, no studies have been carried out on the practical knowledge of health professionals about breast cancer, so we initiated this work whose objectives are the following.
To study the knowledge, attitude and practice of health professionals of the hospital of the district of the commune IV against breast cancer.
Determine knowledge of district hospital health professionals on breast cancer;
Analyze the attitude of health professionals of the district hospital on the policy against breast cancer in Mali;
To evaluate the practice of health professionals in the hospital of the district of commune IV in the management of breast cancer in Mali.
It was a cross-sectional, prospective, qualitative and quantitative study (mixed study). It ran from 01 October 2022 to 31 December 022.
This mixed methodology allows to understand in depth the problem, to treat several aspects of the question, to bring details, to implement holistic strategies to improve the practical knowledge of health professionals in our center.
We carried out a sampling by convenience, concerning all the health professionals selected in the inclusion criteria within the hospital of the district of the commune IV.
Our choice of the suitability method is explained by the fact that in this context, a non-random method is more appropriate, given the practical reasons, including the availability of health professionals at the time of the survey.
All doctors, midwives, nurses and hospital residents of the district of commune IV available during the survey.
Health professionals are not available during the survey.
We used the survey sheet to collect the data.
The survey sheet was tested by administering it to 10 health professionals.
This test helped to correct the deficiencies of the investigation sheet.
The survey sheet is divided into four parts:
The questions focused on:
Definition of breast cancer, prevention, risk factors, clinical signs of breast cancer, breast cancer treatment.
The questions focused on:
The Health Professional’s Perspective on Breast Cancer Prevention;
The health professional’s perspective on breast cancer diagnosis;
Its assessment of the management of breast cancer in Mali;
Its analysis of the policy against breast cancer in Mali.
Promotion of the clinical examination of the breast during consultations.
Promotion of self-catering during consultations.
The indication of mammography.
The advantages of the multidisciplinary consultation meeting (RCP).
The therapeutic means used by the health professional.
How to deal with a suspicion of breast cancer.
How to deal with breast cancer.
The difficulties that healthcare professionals face in the fight against breast cancer.
Responses regarding risk factors, clinical signs and treatment ranked the level of knowledge of health personnel.
Poor knowledge: 0 or 1 risk factor cited by health personnel.
Average knowledge: 2 or 3 risk factors cited by health personnel.
Good knowledge: 4 or more risk factors cited by health personnel.
Poor knowledge: 0 or 1 clinical sign cited by health personnel.
Average knowledge: 2 or 3 clinical signs cited by health personnel.
Good knowledge: 4 or more clinical signs cited by health personnel.
Poor knowledge: 0 or 1 treatment cited by health personnel.
Average knowledge: 2 or 3 treatments cited by health personnel.
Good knowledge: 4 or more treatments cited by health personnel.
The data was entered on the Excel software, the analysis was done with the Epi info 7 software.
We distributed 110 survey sheets among health professionals, 80 health professionals participated in this study after self-administration of the questionnaire, a participation rate of 73%.
Professional status: Professional status is summarized in
General practitioners were the most represented (36.25%); followed by specialists (28.75%).
The male sex was the most represented at 63.75% with a sex ratio of 1.76 in favor of men
The average age was 39.59 years with extremes of 22 and 61 years.
The age group from 20 to 40 years was the most represented, 53.75%.
The average number of years of experience was 11 years with extremes of 0 and 36 years.
Health professionals who received the knowledge in medical school accounted for 71.25%. Those who received breast cancer knowledge through health schools, radio, television and continuing education accounted for 27.50% respectively; 37.50%; 37.50% and 58.75%.
General practitioners were the most represented (36.25%); followed by specialists (28.75%).
Good knowledge of diagnostic means was observed in 47.50% of health professionals.
The multidisciplinary consultation meeting (RCP) was unknown by 56.25% of health professionals.
Knowledge of therapeutic means was good in 61.25% of health professionals.
The breast nodule was evoked in 81.25% of cases, followed by breast discharge (48.75%), pain (43%). Nipple retraction was mentioned in 12% of cases (
Risk factors cited by participants included family history (48.75%); tobacco (48.75%); alcohol (48.75%); contraception (20%); no breastfeeding (18.75%) and hormonal substitution (15%) (
The diagnostic methods discussed by the participants were: mammography (81.25%); biopsy (58.75%); ultrasound (55%).
| Professional status | Workforce | Percentage |
|---|---|---|
| hospital intern | 8 | 10.00 |
| Obstetrician nurse | 3 | 3.75 |
| general practitioner | 29 | 36.25 |
| specialist | 23 | 28.75 |
| midwife | 17 | 21.25 |
| Total | 80 | 100.00 |
| Clinical signs | Workforce | Percentage |
|---|---|---|
| Breast flow | 39 | 48.75 |
| Pain | 35 | 43.75 |
| Orange peel | 20 | 25.00 |
| Nipple retraction | 10 | 12.50 |
| Breast nodule | 65 | 81.25 |
| Risk factors | Workforce | Percentage |
|---|---|---|
| Family antecedent | 39 | 48.75 |
| Early menarche | 5 | 6.25 |
| Late menopause | 4 | 5.00 |
| Contraception | 16 | 20.00 |
| Rayon X | 3 | 3.75 |
| Tobacco | 39 | 48.75 |
| Alcohol | 39 | 48.75 |
| Nulliparous | 7 | 8.75 |
| Breast pathology | 4 | 5.00 |
| Female sex | 5 | 6.25 |
| Age > 40 years | 5 | 6.25 |
| Hormonal substitution | 12 | 15.00 |
| Lack of breastfeeding | 15 | 18.75 |
| Bra | 6 | 7.50 |
The therapeutic methods suggested by the participants were: chemotherapy (81.25%); surgery (75%); radiotherapy (67.50%); hormone therapy (27.50%) and targeted therapy ((5%).
Prevention Perspective:
Participants believe that the screening campaign is struggling to mobilize the population because of the lack of political will, that is to say the absence of mass mammography screening campaign, the lack of awareness on public and private media, insufficient integration of preventive care into care provision and insufficient trained staff.
Among the health professionals, 75% advised women to breast self palpation.
Management Perspective:
Support must be free, the cost of support is unbearable for most families, promote communication for behavior change, subsidize additional examinations and chemotherapy sessions, Making support accessible, even within Mali are the different proposals made by participants.
Among the participants, 68.75% examined the breast during consultations; 31.25% did not examine it during consultations.
Among the participants, 73.75% proposed the reference of breast cancer cases in the treatment centers.
Overall, 23.75% of participants had good knowledge of the signs of breast cancer, 60% had average knowledge, and 16.25% had poor knowledge.
No hospital intern had good knowledge about the clinical signs of breast cancer, specialist doctors had 43.48% good knowledge, general practitioners 24.14%; obstetrician nurses 33.33% and midwives 5.88%.
Regarding knowledge of risk factors, 32 .50% of participants had a good knowledge of risk factors for breast cancer, 38.75% had a medium knowledge.
No hospital intern or obstetrician nurse in the study sample had a good knowledge of risk factors. General practitioners had the highest rate of good knowledge at 51.72%; 43.48% of specialists and 5.88% of midwives had a good knowledge of risk factors.
We conducted a cross-sectional, mixed (quantitative and qualitative) study.
This type of study is interesting because it allows to understand deeply the problem and identify strategies for solving the problem.
It is an original, prospective study, with less bias than retrospective studies.
During the data collection period, 110 health professionals accepted the survey sheets, among these health professionals, 80 participated in this study by self-administration of the questionnaire, a participation rate of 73%.
Our participation rate is close to those of Charlotte Tchente Nguefac and Liese C. C. [
However our participation rate is lower than those of Y. A. Sawadogo and Karima Zine [
This difference could be explained by the lack of culture of qualitative studies, staff may feel that their anonymity will not be respected.
- In our study the mean age was 39.59 years with extremes of 22 and 61 years, the age range of 20 - 40, was the most frequent at 54.75%
We found the same results as Charlotte Tchente Nguefac and Y. A. Sawadogo [
The average age of health professionals in our study was lower than Karima Zine [
This difference could be explained by recruitment bias.
- In our study, male represented 63.75% and female represented 36.25%.
In the other studies, the female sex was the most dominant, so women accounted for 77.85% in the Liese C. C study [
In our study, 33% of healthcare professionals had good knowledge, 39% had average knowledge and 29% had poor knowledge of breast cancer risk factors.
No hospital intern had a good knowledge of risk factors, no obstetrician nurse had a good knowledge, however general practitioners and specialists had respectively 57.69% and 38.46% of good knowledge; 52.17% of midwives had poor knowledge of breast cancer risk factors. In the study by Y. A. Sawadogo [
Samia [
47% of physicians had excellent knowledge and no physician (0%) was considered to have poor knowledge. All the doctors had satisfactory knowledge. In contrast, 56.5% of nurses had poor knowledge and only 1% had excellent knowledge. The average knowledge score for nurses was 43% [
We note a lack of knowledge of breast cancer risk factors by health professionals, in our study as well as in those of the authors Burkinabés [
Nevertheless some diapers make a good impression, 57.69% of general practitioners in our study had good knowledge, 63.6% of gynecologists in the Y. A. Sawadogo study [
In our study 23.75% of health professionals had a good knowledge of the signs of breast cancer, 60% had an average knowledge, 16.25% had a weak knowledge.
No hospital intern had a good knowledge of the clinical signs of breast cancer, specialist doctors had 43.48% of good knowledge, general practitioners 24.14%; obstetrician nurses 33.33% and midwives 5.88%.
In the study of Y. A. Sawadogo [
Liese C. C et al. [
In the various studies [
Health professionals who received breast cancer knowledge at medical school accounted for 71.25%. Those who received breast cancer knowledge through health schools, radio, television and continuing education accounted respectively 27.50%; 37.50%; 37.50% and 58.75%.
Liese C. C. [
Participants who knew the signs of breast cancer on Radio accounted for 73%.
Participants who saw the signs through the capacity building trainings accounted for 56%.
Karima Zine [
Jean Dupont Kemfang Ngowa [
Health professionals who received knowledge through radio and television in our study have lower results than the (Liese C. C.) study. This can be explained by the development of other means of communication such as social networks.
We have the same results as (Liese C. C.) [
In our study, 75% of health professionals advised women to breast self-palpation.
Jean Dupont Kemfang Ngowa [
Gynecologists, general practitioners, midwives and state nurses advised women to breast self-palpation, respectively 77.77%, 42%, 50.81% and 25%, reported by KOUAMO II Eitel Igor) [
Our result is higher than that of Jean Dupont Ngowa [
In our study, staff reported that the delay in diagnosis can also be explained by several factors, among which we have: financial, cultural and religious barriers, social beliefs, ignorance, bad practices, the lack of knowledge of self-medication, the impracticality of self-palpation, the early use of traditional treatment, the denial of the diagnosis or treatment proposed by the doctor in favor of traditional treatment.
Forty-two percent of physicians and 53.5% of other participants believed that breast cancer could go away after prayer [
In the Samia Ghanem study [
Among the nurses, only 22% believed that herbal treatments or alternative medical therapies cannot cure breast cancer and only 40% among nurses believed that breast cancer cannot go away after prayer without treatment.
In our study, all participants stated that breast cancer screening was essential, however, it is clear that the screening campaign is struggling to mobilize the population because of the lack of political will. That is, the absence of a mass mammography screening campaign, insufficient awareness of public and private media, insufficient integration of preventive care into care offerings and insufficient trained staff.
In the study by Y. A. Sawadogo [
KOUAMO II Eitel Igor) [
We have the same results as the different authors [
In our study, 68.75% of participants performed the clinical examination of the breast (ECS) during consultations.
Samia Ghanem [
- In the study of Y. A. SAWADOGO [
Nasiru A Ibrahim [
Our result is lower than those of the other authors [
In our study, the screening methods evoked by the participants focused on mammography in 81.25% of cases.
Mammography in women aged 50 and over is seen as highly effective by 98% of physicians and 95% of nurses in screening, as reported by Benjamin D [
Y. A Sawadogo [
In the presence of evocative signs, in the study of KOUAMO II Eitel Igor) [
In many respects, mammography would be considered the main method of screening and diagnosis, it is made an abusive indication, the indications of ultrasound and mammography must be respected.
We found the same results as Y. A. Sawadogo [
However our result is higher than that of KOUAMO II Eitel Igor [
We conducted a cross-sectional, quantitative, qualitative study over 3 months (from 01 October 2022 to 31 December 2022).
This study is interesting because it allowed us to have data on the attitude knowledge and practice of health professionals in the hospital of the district of the commune IV of Bamako.
However it has limitations, the sample size is not large, it is a single-center study, a multicenter study was going to give a large sample and great power to the study.
Early detection of breast cancer cases during regular consultations;
The organization of screening campaigns;
Promoting breast self-palpation among women;
Involvement of the press in communication for behavior change.
Training of health professionals in the management of breast cancer;
The implementation of a follow-up plan/evaluation of breast cancer control activities;
The endowment of the hospital with material resources for the fight against breast cancer.
Supporting health professionals and decision-makers in the implementation of policies to fight breast cancer.
Participation in breast cancer control activities.
Breast cancer is a common pathology throughout the world, health personnel are at the forefront of the fight against breast cancer, and this fight cannot be effective without trained personnel.
The authorities are struggling to mobilize the various stakeholders in the fight against breast cancer.
Although some efforts have been made, it is nevertheless important to revitalize the policy against breast cancer, through strategic axes, such as staff training, the establishment of infrastructure, the subsidy of acts, good communication about breast cancer.
The authors declare no conflicts of interest regarding the publication of this paper.
Samaké, M., Dembelé, S.B., Diarra, S., Dianessy, Y., Guiré, A., Yede, D.L.S., Saye, A., Dembele, B., Traoré, B., Nadio, T., Maiga, I., Dicko, M., Diarra, M., Konaté, S., Maiga, A., Dembele, B.T. and Togo, A. (2024) Knowledge Practical Attitude of Health Professionals on Breast Cancer at the Hospital of the District of the Commune IV of Bamako. Surgical Science, 15, 342-356. https://doi.org/10.4236/ss.2024.155032
I) ADMINISTRATIVE DATA
Age Sex
Profession Quarter
Marital status Ethnicity
Level of study:
Service:
Number of years of professional experience:
Professional Status:
Specialist, General practitioner, intern, midwife, obstetrician nurse
Total number of participants:
II) KNOWLEDGE OF BREAST CANCER
Q1: How will you define breast cancer?
Q2: What is the incidence of breast cancer?
a: 1 - 1.5 million yes no
b: 1.5 million - 2 million yes no
Q3: Can breast cancer be cured?
a: yes b: no
Q4: What is the prognosis of breast cancer?
Q5: What preventive measures against breast cancer do you know?
Risk factors
Q6: What are the risk factors for breast cancer that you are aware of?
Clinical signs
Q7: What are the clinical signs of breast cancer that you are aware of?
Diagnostic
Q8: What are the diagnostic methods of breast cancer that you know?
Q9: What are the therapeutic ways you know?
Q10: What are the sources of knowledge:
Medical School: yes no
Nursing School: yes no
Radio: yes no
Television: yes no
Training/capacity building yes no
Other sources of information:
III) ATTITUDE TOWARDS BREAST CANCER
Q11: What is your view on breast cancer prevention?
Q12: What is your point of view regarding the diagnosis of breast cancer?
Q 13: How do you like the management of breast cancer in Mali?
Q14: What analysis do you make of the policy against breast cancer in Mali
IV) PRACTICAL
Q15: Do you examine the breast during your consultations?
Yes No
If so, what should be the frequency of this examination?
Q16: Do you advise women to self-examine during your consultations?
Yes No
If so, what should be the frequency of this examination?
Q17: What age group is asked for mammography for breast cancer screening?
a: 25 - 40 years yes no
b: 45 - 74 years yes no
Q18: Have you ever heard of the Multidisciplinary Consensus Meeting (MCM)
Yes No
Q19: If so, what are the benefits of MCM?
Q20: What are the therapeutic means you use?
Q21: In a few words, what do you do with a suspicion of breast cancer?
Q22: In a few words, what do you do about breast cancer?
Q23: In a few words what are the difficulties you face in the fight against cancer?