Knowledge of breast cancer in women in Sierra Leone

Curationis 29(3): 70-77 Breast cancer has been described as one of the life-threatening diseases affecting women and is a major problem in women’s health issues. The unrecorded number of cases of breast lumps and breast cancer observed in women in Sierra Leone prompted the researcher to organize a “Breast Week” during which 1 200 women were educated on breast cancer and the importance of breast health. This research is a follow up of the “Breast Week” which was organized in Freetown, Sierra Leone The specific objective of this study was to assess whether the knowledge and teachings given to the women who participated in this project was fully understood. A sample size of 120 women (10%) who participated in the “Breast Week” was obtained through systematic


Introduction and problem statement
Cancer was previously known to be a disease of the affluent world, but in recent years the in cid en c e o f ca n cer in developing countries has soared (WHO, 1997:2).According to the World Health Organization (Smyke, 1993:19) cancer is now also a third world problem, and if existing trends continue, cancer mortality is expected to rise in the future in nearly all regions of the world (Smyke, 1993:19).Breast cancer is said to be the leading cause of cancer among women in most d ev elo p ed c o u n trie s and in m any developing countries (Smyke, 1993:95).

Curationis August 2006
In South Africa, the Cancer Association o f South A frica (C A N SA , 1993:1) estimated that cancer affects over 4,000 w om en per year and th at the m ost common cancers are breast and cervical cancer.According to the American Cancer Society, about 1 in every 8 women in the US is likely to be affected by breast cancer.Every year, 40% of these women die from the disease."There has been an increase of 22% in breast cancer mortality over the past two decades" (Smyke, 1993:95).A quarter of breast cancers are diagnosed before the age of fifty, and the survival rate is five years after detection of the disease (CANSA, 1993:1).Breast cancer is and still remains one of the cancers affecting all age groups of wom en w orldw ide (W HO, 1997:3)."Treatment is less successful for breast cancer than for cervical cancer" (Smyke, 1993:95).There are different patterns in the incidence of breast cancer between women in industrialized countries and th o se in the d ev e lo p in g co u n trie s (Smyke, 1993:19).In the industrialized countries, lung cancer is said to be replacing breast cancer as the m ost common cause of death due to cancer among women (Smyke, 1993:95).Smyke further notes that, for the most part, the differences reflect differing lifestyles but that th ese p attern s ch ange rap id ly (Smyke, 1993:25) and that one-third of cancers could be prevented if women are armed with the right knowledge.Current trends in women's health globally, are revealing the high incidence of breast cancer in women (Smyke, 1993:95).
Despite recognition of this fact, a country like Sierra Leone has no breast cancer policy in place to address this threat.P resen tly , th ere is no in stitu te undertaking research in cancer in the country and no screening facilities, e.g. a mammogram, available in the whole country.The researcher had noticed that several women, young as well as old, nurses as well as laypersons, had had recent surgery to remove breast lumps or had died of breast cancer.These cases have gone unresearched except for the case histories as told by the survivors themselves.Furthermore, studies have not been conducted to determ ine the severity of this problem in Sierra Leone.
Sierra Leone as a country is faced with the problem of accessing reliable data.This situation has been worsened by the 10-year rebel war in the country when a num ber o f h ealth fa c ilitie s w ere destroyed and rendered non-functional (UNICEF, 1999:145).Women do not have access to vital information regarding their health.Basically, women rely on radio discussions or health talks during visits to the antenatal clinic for information on reproductive health.
Emphasis on early detection is seen as vital especially in developing countries where there is no access to modern technology to detect breast cancer.The lack of basic knowledge and an effective information delivery system for breast cancer further threatens the life and well being of women.Breast cancer is silently killing women, many of whom have no knowledge and continue to be ignorant about b reast can cer and screening methods for early detection.Findings from this study will serve as an initial stepping stone and starting point to meet the growing challenges of breast cancer that are currently going unnoticed in Sierra Leone.

Setting
The study was conducted in Sierra Leone, a country located on the west coast o f A frica between Guinea and Liberia.It has an area of about 72, 800 square kilometres.Freetown is the capital city of Sierra Leone and is located in the western part of the country.In 2000, Sierra Leone had a population of a little over 5 million, 51 % of whom were women.Sierra L eone is rated as one o f the least developed countries with the lowest quality o f life and wom en are at a d isad v an ta g e in term s o f literacy (UNICEF, 1999:67).The country was plagued by a ten-year rebel war which has further compounded the problem of women gaining access to quality care and inform ation on w om en's health issues.
During clinical practice the researcher had observed that there appeared to be more women admitted to the hospital with breast cancer.Some of the women had sought help from traditional healers and had com m enced traditional healing methods such as applying herbs to their breast.This resulted in inflammation of the breast and it was at this stage that they reported to the hospital seeking medical help.It was not known whether these women recognized the serious nature of breast cancer or knew the signs and symptoms of the disease.It was ag ain st th is back g ro u n d th at the researcher organized a "Breast Week", as part of health promotion activities, to educate women on breast cancer.
A radio discussion on breast cancer and m ethods o f d e te c tio n w as held in Freetown prior to the breast week.The 'Breast Week' was advertised on the radio programmes and in the communities by nurse-midwife tutors and nurse-midwives in tra in in g .O ver 1 200 w om en participated in the breast week and had their names and contact details entered in a registration book.These women received health education in order to create an awareness of breast cancer, m ethods o f early detection and the im p o rtan ce o f early re p o rtin g o f

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Curationis August 2006 abnormalities of the breast to the hospital.They were informed that they could be contacted by the researcher in future for future studies to which they all agreed.This study was therefore a follow up measure by the researcher to ascertain whether the information provided during the breast week on breast cancer was und ersto o d by the w om en.An assessment of the effectiveness of the proceedings during the breast week was the prime focus of this study.

Purpose and objectives of the study
The p u rp o se o f th is study was to evaluate the knowledge of breast cancer in women in Freetown and its impact towards reinforcing positive learning outcomes.The main focus of the study was breast cancer as one of the diseases affecting women.The objectives of this research were to: • To assess if the information given to the women regarding breast cancer during the breast week was fully understood.

•
To assess if the information given during the breast week had created an awareness on the serious nature of breast cancer.

•
To identify gaps, weaknesses and strengths in the knowledge imparted during the breast week.

Significance of the study
The inform ation generated from this study w ill contribute to im proving awareness on the level of knowledge of women on m atters regarding breast cancer.Findings will be utilised in formulating teaching plans to address issues such as breast health among women at all levels in the Sierra Leone com m unity.T h erefo re gaps and deficiencies highlighted in the study could co n trib u te to h ealth serv ice planning.

Validity and reliability
A pilot study was conducted before the actual study started as a m eans of d eterm in in g the re lia b ility o f the instrument.This involved testing the actual instruments on a small sample taken from the sample population under study (Polit & Hungler, 1997:44).The pilot study was conducted a week before the study was carried out.Five women were selected from the target population.These women were not included in the m ain study.T he co n ten ts o f the stru ctu re d in terv iew schedule administered to the women were limited to only health teachings given during the breast week.

Ethical considerations
Permission to undertake this study was sought from the University's Research Ethic Committee; the Ethics Committee on Health, Freetown, Sierra Leone; the Consultant in-charge of the main referral hospital and the participants.Informed co n sen t was o b tain ed from the p artic ip a n ts.
A n onym ity and c o n fid e n tia lity w ere ensured.P a rticip atio n in the re searc h was voluntary.Participants were offered the opportunity to withdraw from the study at any time and were assured of no ill effects.P a rtic ip a n ts w ere given a pam phlet on breast self-exam ination (BSE) and a pink ribbon as a token of appreciation for participating in the study.

Literature review
According to Fentiman (1999:42), breast cancer is the most prevalent type of cancer in women.Similarly, CANSA (2000:1) reports that breast cancer is one of the most common cancers among South African women affecting over 5000 women per year.Breast cancer is said to be the most prevalent cancer amongst W hite fem ales and the second most common cancer amongst Black women.

Incidence
According to CANSA (2004:1), one out of ten lumps in the breast is cancerous.In South Africa in 1988,3324 per 100,000 women were diagnosed w ith breast cancer.The age group most commonly affected was between the ages of 55 and 85 years, with the highest incidence amongst the 80-84 year age group (South A frican N atio n al C ancer R egistry, 2001:1).The American Cancer Society estimated that approximately 130,900 new cases of malignant breast tumours were discovered in 1987, and approximately 41,300 w om en died o f the disease (American Cancer Society, 2003:1).In the United States, the overall incidence of breast cancer increased in the early 1970's to the early 1990's and then decreased approximately 0.6% from 1991 (American Cancer Society, 2003:1).This drop has been linked to advances in medical research and earlier detection of the disease.Consequently, the overall survival rates have increased.

Risk factors
Breast cancer is an issue of concern for every w om an in to d a y 's society.A ccording to the N atio n al C ancer Institute (2002:1) being female is the highest risk factor for breast cancer, one out of eight women in the United States has a lifetime risk of developing breast cancer.Increasing age is discussed as the second highest risk factor (American Cancer Society, 2003:2).Breast cancer is said to be common in W hite women across all age groups and is more frequent in black women under the age of 45 (Keitel & Kopala, 2000:13).Seventy five percent of new cases of breast cancer are said to occur in w om en age 50 and older.However, Keitel & Kopala (2000:13) have stressed that younger women tend to experience a higher mortality from the disease.
The Cancer Association of South Africa (2004:1) included in their list, risk factors such as obesity, early onset of menses, late m enopause, p ro lo n g ed use o f hormone replacement therapy with high dosage, and a high fat diet.In addition to the above mentioned, Keitel & Kopala (2000:15) list age, genetics, hormonal activity, lifestyle factors such as diet, and excessive alcohol use as contributory risk factors.Personal or family history of breast cancer and environmental factors are also said to be risk factors for breast cancer (Dixon, 1995:19).However, Keitel & Kopala (2000:15) state that although a family history increases one's risk, 70% of women diagnosed with breast cancer had no known risk factor.It was further disclosed that women who once had breast cancer are at increased risk for a new primary breast tumour.Smoking was also id en tified as a risk fa c to r for developing breast cancer and research findings have established that smokers have a 25% greater risk of dying from breast cancer than non-smokers (Keitel & Kopala, 2000:16).In addition to these factors, Keitel & Kopala (2000:16) cited stress and depression as being linked with breast cancer.They however concluded that this theory has not yet been proven by research.

Detection
Detection of cancer at an earlier stage is linked to better outcom es (H askell, 72 Curationis August 2006 1995:10).An article by the C ancer A ssociation o f South A frica (h ttp :// www.cansa.co.za) states that "Breast cancer can be cured if caught on time".The need for one to be knowledgeable about their breasts has been discussed by Northrup (1999:313).Similarly finding out about the status o f the breasts is being pro m o ted by B reast C an cer Associations worldwide as no one is im m une to breast cancer (N ational Cancer Institute, 2000:1).In a pamphlet on breast cancer, the Cancer Association of South Africa (2000:1) stressed that regular examination can set women free and that early detection is the key to survival.In order for a woman to detect breast cancer early she needs to be aware of the changes that are suggestive of breast cancer.
This intervention involves performing m onthly b reast se lf-e x a m in a tio n , observing for and noting abnorm al changes in the breasts and reporting to the doctor promptly.An annual physical ch eck up by the d o c to r is also recommended.Women are also advised to go for a mammogram especially if they happen to be in the high-risk group (Berger & Bostwick, 1994:22).Another new d evelopm ent in b reast ca n cer detection is that of using heat sensitive pads (A m erican F am ily P h y sician , 2003:2).These pads are worn inside the brassiere and act as an early indicator of breast cancer.Currently it is approved as a supplement to the more traditional tests (American Family Physician, 2003:2).

Diagnosis
Watts (1990:4) maintains that the exact mechanism by which a cancer arises is complex and poorly understood and the growth pattern and metastatic potential of a cancer is usually predetermined in advance before clinical detection of the cancer.In order to m ake a proper diagnosis, Keitel & Kopala (2000:20) point out that it is imperative for a woman to be referred to a breast surgeon for consultation if a solid mass or abnormal change is detected.However, there are some observed abnorm al changes or breast lumps that are not cancerous.One of the traditional m ethods o f breast cancer screening includes clinical breast examination (CBE).LoBuono (2001:1) describes CBE as being an integral part of a complete breast cancer-screening program in which a physician palpates the breasts, looking for subtle changes in the breast tissue.Diagnosis of breast cancer is only made after a thorough examination by the doctor followed by the necessary investigations.Biopsies are generally performed to determine whether a lump is cancerous (Huffman, 2000:1).Watts (1990:134), how ever m aintains that with the use of breast screening procedures some cancers can be detected.The mammogram is an x-ray examination of the breast tissue done by a radiologist in a breast diagnostic centre or at the physician's office.It is used as a screening method for breast cancer as well as in its diagn osis (B erger & Bostwick, 1994:20).An expert radiologist may be able to diagnose some benign conditions.

Treatment and effects
Treatment of breast cancer is dependent on the stage and type of cancer as well as the age and health of the woman (H askell, 1995:21).L iteratu re also supports the fact that early detection and diagnosis are the best treatment of breast cancer (Berger & Bostwick, 1994:12).Basically, the treatment of breast cancer involves surgery in which the lump or the whole breast is removed in addition to the surrounding lymph nodes (Haskell, 1995:18).This management is performed in conjunction with radiotherapy.In the late stages, or to prevent reoccurrence, chemotherapy is used alongside surgery and radiotherapy (Dixon, 1995:43-44).Endocrine therapy and vaccines are also part of the treatment offered to women who are likely to develop cancer or are affected with cancer (Haskell, 1995:21).Haskell (1995:22) however noted that the treatm ent of each patient should be individualized.Breast cancer and its trea tm e n t have p h y sical and psychological implications for women.
Physical and psychological trauma are associated with breast surgery (Keitel & Kopala, 2000).If treatment of breast cancer involves mastectomy, a woman is faced not o nly w ith the p ro sp e ct o f a frightening disease, but also with the loss of a part of her body which is essential to her feminity (Keitel & Kopala, 2000:28).Women who are concerned about their body image after removal of the affected b reast o ften opt for reconstruction surgery.T h is in v o lv es tissue re p la cem e n t and p la stic surgery.Advancem ent in technology has also made it possible for women to wear prostheses under their clothes to make the breasts appear normal.

Prognosis
The p ro g n o sis o f b reast ca n cer is influenced by a myriad of factors some of which cannot be prevented (Haskell, 1995:10).So far there is no specific in te rv e n tio n to stop cancer, but according to researchers if cancer is detected in the early stages the prognosis is good (Keitel & Kopala, 2000;Haskell, 1995:10).The chances of a complete recovery from breast cancer are highest (90% +) when the disease is detected early (National Cancer Institute, 2000:2).This m eans that the p ercentage of patients surviving five years or longer afte r d iag n o sis o f b reast cancer, apparently detected the cancer at its early stage.If this is the case, then women need to be more knowledgeable about their body's function in order to note abnormal changes.The overall impression is that the prognosis of breast cancer depends not only on a single factor but on several of them.

Theoretical framework
Orem's Self-Care Nursing Model (1980) was selec ted fo r this study, as it addresses the key concepts o f this research.Lack of knowledge of breast cancer and methods of detection spell out the "Self-Care Deficit" according to O rem 's p e rsp e c tiv e .P ro v isio n of knowledge and skills is required if the care abilities are less than those required for meeting a known self-care demand.Information is power and helps bring about a ch an g e in attitu d e .An environm ent that prom otes personal development in relation to becoming able to meet those needs is required (Orem, 1980:52).

Research Design
A quantitative, descriptive-exploratory research design was used to assess the knowledge of breast cancer in women in Sierra Leone.A structured interview schedule consisting of two sections was adm inistered to the respondents as a means of collecting data in order to arrive at responses that could be quantified and analyzed as numeric values.The first section covered the socio-demographic information of the respondents, whilst the second sec tio n co vered the theoretical knowledge base of breast cancer.

Population and Sample
The target population for this study was those women who attended the 'Breast Week'.A total number of over 1 200 women participated in the 'Breast Week' held in November 2002 in Freetown, Sierra Leone.Every tenth w om an on the registration list of women who took part in the 'Breast Week' was systematically selected as a participant for this study, giving a total of 120 women.

Data Collection
The data were collected over a period of four weeks.The participants for this study were contacted through a list containing their nam es and contact addresses.Their permission to participate in the study was sought verbally and informed consent was obtained.Based on this, a structured interview schedule containing coded items in the form of closed and open-ended questions was administered to the 120 women.The first section of the interview schedule focused on socio-demographic data relevant to the study.The second section of the interview schedule contained questions focusing on the knowledge base of breast cancer, its causes, treatment and early detection methods.

Data Analysis
Data were analyzed using SPSS 11.5 and Microsoft Excel.Open-ended questions were analysed by grouping, in order of sim ilarity the view s expressed .Appropriate coding was allocated to the various groupings.Statistical tests were applied to variables such as age and level of education.The data did not lend itself to tests of statistical significance.

Socio-Demographic Data
One hundred and tw enty w om en participated in the study.Their ages ranged between 18 and 50 years and above.Half of the women fell within the age group 31 -50 years.The majority of the women, (77.5 %), were married.Only 9.2 % of the women were single and 5.8 ' % were widows.The majority of the respondents, (70.8 %), were traders who engaged in small and big businesses, 6.7 %, were students, 50.8 % had had no formal schooling, 34.2 % had junior and secondary level education, with 11.7 % having com pleted senior secondary schooling.None of the respondents had post school education.The total number of respondents who had received some form of schooling (59%) was almost the same as those who had never been to school (61 %).A very large percentage of

Social Habits and Life Style
With regards to lifestyle, the majority (84.2%) reported that they did not drink alcohol.Those who drank alcohol (15.8 %) differed in the type and amount of alcohol consumed per week.An even greater number, (92.5%), responded that they did not smoke cigarettes.Over onethird (38.3%) chewed kola nuts and did so in varying amounts.Kola nuts are found in countries such as Sierra Leone, Liberia, Guinea, and Gambia and are renowned for their addictive properties.
It is a habit forming nut with a high caffeine content and is used as a pastime by some people in Sierra Leone.Kola nuts are used in making certain drinks such as coke, dye making and in traditional rites such as en g ag em en ts or fu n eral ceremonies by certain tribes.

Reproductive Health History
Age at onset of menarche has been used as one of the risk indicators for breast cancer (Berger & Bostwick, 1994:291).
The greater percentage of the women (85 %) reported having their first monthly period between the ages 12-15 years, 9.2 % reported starting after the age of 15 years and 5.8 % reported experiencing their first menstrual period at age 9-11 years.A lm ost all (97% ) o f the respondents had children.Those who had up to three children constituted 36.7 % o f the sam ple and those having delivered 4-7 children amounted to 47.5 %.A small group of respondents (15.8 %) had delivered eight or more children.
A lm ost tw o-thirds (64.2 %) o f the respondents had had their babies whilst aged 18-25 years.The analysis further showed that 24.2 % of the respondents had their babies at age 18 and below.Only 3.3% of the respondents had their first babies at age 34 years and above and another 3 % had no children.
With regards to breast feeding, all those who had had babies, breast fed all of their children giving a 100% breast feeding response.The majority (69 %), breastfed their babies for 1-2 years.Another 31 % breast fed for more than 2 years.In terms of contraceptive use, just under twothirds o f the respondents, (63.3 %), indicated that they had never used contraceptives, whilst 36.7% had used contraceptives.O f the 26 respondents currently using a contraceptive, 14 were using an injectable contraceptive.Only five reported using oral contraceptives and another five had had an IUCD inserted. 74

Knowledge of breast cancer
In response to the open-ended question "W hat do you know ab o u t b re ast cancer"?A number of varied answers and responses were given.These responses were summarized and categories are listed in Table 1.Just over h alf (58.8 %) described breast cancer as a disease that affects the breasts and kills women if not treated or reported early.Just under half (42.0%) listed some of the signs and symptoms associated with breast cancer.Similarly, abnormal growth, enlargement, and skin changes were cited as indicators o f b reast ca n c e r by 10% o f the respondents.A bnorm alities such as nipple discharges and hardening of the breasts were also cited by 10% of the respondents.A sm all percentage o f respondents (3.4%) indicated that they did not know what breast cancer was.

Causes of Breast Cancer
This was an open ended question, asking "W hat causes b reast c a n c e r" ?The breakdown of varied responses on the causes of breast cancer is displayed in

Discussion
This study showed that 58.8% of the women could describe breast cancer as a life-threatening disease affecting women.
There was however lack of knowledge of breast cancer expressed by some of the women (3.4%) despite the educational activities during the breast week.One possible explanation could be that almost half of the sample (61%) did not obtain formal schooling.This is consistent with the statistics of the country which reflect a low level of educational attainment and a high level of illiteracy among the women (UNICEF, 1999:69).Ahigh participation of the women involved in trading was evident in the analysis.A possible explanation for this is that the hospital is located within walking distance of the market.
The literature infers that alcohol, cigarette smoking, a high caffeine intake, and an early menarche are relevant risk factors in breast cancer (Northrup, 1999:337).
The results of this study showed that smoking was not a common habit among the w om en.S im ilarly, alcohol was consumed by only 10 women.Africa, 2000:49) and also if the age of giving birth to the first child is over 30 years (Berger & Bostwick, 1994:291).Findings in the study showed that most of the women had large families and those who had had babies, breastfed all of their children for relatively long periods.The majority of the respondents, (63.9 %), breastfed their babies for 1-2 years.
Findings in this study also supports the fact that African mothers are known to practice breast feeding for longer periods some even up to two years (UNICEF, 1999:24).It can be argued then that women in African countries are at an advantage over countries where women do not breastfeed.
The need for comparative studies of the lifesty les o f w om en in dev elo p ed countries and developing countries and associated risks of breast cancer is of relevance.It is apparent from the study that these women practiced breastfeeding in line with cultural expectations and did not attribute it to a health practice associated with risk reduction of breast cancer.The need for nurses to identify and reinforce these positive health habits during health education and health promotion is important.
The findings suggest that the majority of the women had a good knowledge of what breast cancer is, as they ably described the disease in terms of signs and sym ptom s asso ciated w ith the disease.T he w om en could nam e abnormalities of the breast and linked the disease to the signs and sym ptom s associated with it.They recognized signs such skin changes and hardening of the breast as abnormal.This indicated that the women were aware of the serious nature of the disease.There was however a small number who mentioned that they did not know what breast cancer is.The development of an effective information system to constantly sensitize women on issues re g ard in g th e ir h ealth is paramount especially for women who have no o th er m eans o f accessing information.Considering the fact that nearly half of the respondents had no formal schooling, it is possible that they felt that they could not accurately describe the disease based on their level of understanding of the disease.Radio talks and mass media campaigns can be used to target women at grass roots level to continue to raise awareness on matters regarding their breast health.
In this study, the women (5%) who stated that the cause is unknown appeared to be the m ost k n o w led g eab le.T his statement is supported by the literature as medical experts also state that the exact causes of breast cancer remain unknown (Huffman, 2000:2;Watts, 1990:4).Almost 72% of the women cited putting of coins or metal in their brassiere as a possible cause of breast cancer.On observation, the researcher sees this belief as one that is commonly shared by most women in the traditional communities in Sierra Leone.Keitel & Kopala (2000:16) state that beliefs such as not w earing a b rassiere or w earing an ill fittin g b rassiere, o v eractive or aggressive fondling o f the breasts are held by women as being responsible for causing breast cancer.However, Keitel & Kopala (2000:18) state that there is no evidence to support these beliefs.Nonetheless, women continue to believe that these events or conditions can cause cancer.
Further research needs to be done to explore further traditional beliefs and myths and how they affect w om en's health.A gain the role o f nurses in research and the mass media in dispelling these myths is critical.The reality of the number of women dying from breast cancer was evident in the study as 59.2% of the women said that they knew of som eone who suffered from breast cancer.Almost two-thirds of the women stated that the women known to them had died before or after surgery.It was not clear however whether these women reported the disease at a later stage.T hese fin d in g s have far reach in g im plications for the developm ent of reproductive health policies on breast cancer screening for women in Sierra Leone.

Recommendations
Nursing Practice The issue of breast cancer is relevant in nursing and deserves special attention.The role of a nurse as a teacher, counselor and educator is crucial in women's health and cannot be underestim ated in the health education of clients as discussed in Orem's Self-Care Model.This study dem onstrated the beliefs and m yths associated with the causes o f breast cancer.This finding suggests that more education and means of disseminating information on breast cancer is needed.Positive habits such as breast feeding habits should be further reinforced through health ed u c atio n and the benefits promoted among women.

Nursing Education
Nursing and midwifery curricula must include information on breast cancer and methods of screening for the disease.Breast cancer should be included as an im portant topic in w om en's health program s for nurses as a way o f empowering women with knowledge on breast health.

Conclusion
Findings in this study highlight the issues surrounding women's knowledge of breast cancer in Sierra Leone.Given the observations of the researcher which motivated the "Breast Week" and the number of women in the study who knew of women who had breast cancer, there is the need for empirical studies to be conducted at national level.

Table 2 .
Nearly three-quarters (71.7%) of the respondents linked putting coins and other metals into one's brassiere as one of the causes of breast cancer.A small number, (10.8 %) had no knowledge of