Promoting early diagnosis of breast cancer in Nigeria with Know Your (green) Lemons

While incidence of breast cancer is declining in many parts of the world, in Nigeria, it is increasing. Annually, Nigeria has the highest number of deaths from breast cancer in Africa, estimated at 10,000, with 50% of women diagnosed at stage IV, when it is unsurvivable [1]. While it is unclear why symptoms are presented so late - taboo, fear and lack of health literacy are likely contributing factors.[2]

Without a population screening program in Nigeria, breast cancer symptom awareness and reporting changes are key to early detection. Working with Run for a Cure Africa, Nigeria and their Executive Director, Ebele Nwankwo, PhD, we are testing our hypothesis that by educating in a visual way the messages of symptoms will be well known and easier to identify and report, resulting in fewer deaths from breast cancer in Lagos.

From June-August 2018, RFACA held screening and education sessions in Lagos with 1061 women with the Know Your Lemons® images. Fridge magnets and leaflets were distributed to every woman attending the sessions. From pre and post session surveys we learned:

96% of participants feel confident in recognizing a sign of breast cancer

98% say they will go to a doctor if they see a possible symptom

92% will share the lemon image with family/friends

Tactile knowledge of a cancerous lump increased from 27% to 70% (n=427)

Our research continues. On the fridge magnet and leaflet, we included a dedicated phone number at Run for a Cure Africa which women can call if they notice a breast change. This allows us to record the outcome of the patient referrals and track the stages of the diagnosis against baseline data.

We are also exploring the reasons for late presentation. To date we have have learned 72% of women surveyed said nothing would keep them from telling a doctor about a possible symptom. Only 17% said worry about getting a positive diagnosis would keep them from investigating and 9% said worries of the cost of seeing a doctor would be prohibitive. But when asked if they would have treatment if they were diagnosed, 55% said yes. 25% said costs would prevent them. 11% were concerned about appearance changes. Only 3% believed treatment would be unsuccessful. n=427

For more, see our Abstract from the World Cancer Congress 2018 in Kuala Lumpur.

1. Adisa, et. al, 2011; Eke, Ojo, Akaa, Ahachi, Soo, & Adekwu, 2017; Osaro, 2016)

2. Agbaet al., 2012; American Cancer Society, 2011; Cancer Today, 2012; Osaro, 2016; Prevalence of Breast Cancer, 2015