CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Cancer is a group of heterogeneous diseases that can affect almost any part of the body and

has many anatomic and molecular subtypes, each requiring specific diagnostic and

management strategies. Comprehensive cancer control consists of core components

prevention, early diagnosis and screening, treatment, palliative care and survivorship care

that should be addressed in detail by a national cancer control plan (NCCP), evaluated

through a robust monitoring mechanism that critically includes cancer registries and is

founded on integrated, people-centred care. (WHO, 2016)

Cancer control is a complex undertaking that is successful only when the health system has

capacity and capability in all of these core domains and when investments are effectively

prioritized. Cancer early detection approaches include screening programs, early clinical

diagnosis and a high level of awareness among the general public and health professionals in

addition to well-developed and accessible health services supported with adequate

infrastructure and trained human resources. Developing and implementing National cancer

control programmes as advocated by the World Health Organization provides an effective

and pragmatic framework to develop early detection, treatment and follow-up care services as

a continuum in less developed countries (WHO, 2016).

Approximately two thirds of global cancer deaths are in less developed countries, where case

fatality rates are higher due to late-stage presentation and less accessible treatment. Cancer

remains a significant problem for women. When detected early, cancer is more easily treated

and the possibility of long-term cure is greatest. Nurses play an important role in the

prevention and early detection of cancer in women. Nurses can serve as role models to

women by incorporating cancer prevention and detection practices into their personal health

1
behaviors. Nurses also have many opportunities to incorporate primary, secondary, and

tertiary prevention methods into their practice, regardless of the setting. The impact on

quality of life and decreased mortality as a result of implementation of prevention and early

detection practices is significant (WHO, 2007).

The consequences of delays in care and advanced cancer are dire – the likelihood of death

and disability from cancer increases significantly as cancer progresses. It is therefore critical

to identify barriers to timely diagnosis and treatment and to implement programmes that

provide access to care for all. The core components of cancer control have been described

previously in the WHO.

Cancer control: knowledge into action series. The Early detection module describes the two

approaches that enable timely diagnosis and treatment of cancer:

(ii) Early diagnosis, that is the recognition of symptomatic cancer in patients; and (ii)

screening, which is the identification of asymptomatic disease in an apparently healthy target

population.

This guide further explores the importance of early diagnosis in comprehensive cancer

control. Understanding the role of early diagnosis enables health planners to effectively select

and implement programmes that provide a population with the benefits of finding cancer as

early as possible: improved outcomes and effective utilization of resources.

Early diagnosis programmes include increasing awareness about the first signs of cancer

among the general public, but also among doctors (in particular primary health care

providers), nurses and other health care providers; and improving accessibility and

affordability of diagnostic and treatment services, and improving referral from primary care

providers to specialised doctors and centres. Early diagnosis aims at reducing the proportion

of patients who are diagnosed at a late stage. It is particularly relevant in cases of cancers of

the breast, cervix, mouth, larynx, colon and rectum, and skin.

2
Cancer registries are systems for data collection, storage, validation and analysis, which

allow for extracting and disseminating information on cancer incidence, mortality, survival,

and prevalence rates, time trends, and projections in the populations covered. On a more

advanced plan, cancer registries can give information on the stage at diagnosis, diagnostic

and treatment delay, type of treatment, medical equipment use, and compliance with clinical

care guidelines.

Cancer registries have a key role in:

Epidemiologic research, for monitoring the trends of cancer incidence, survival, and

prevalence rates in geographical areas, social groups, or time periods;

Investigation of aetiological factors for cancer, by supporting the analysis of the impact of

different social or environmental factors on cancer risk;

public health policy measures:

Planning of cancer control measures, helping to prioritise different actions according to the

current and projected cancer burden; of assessment and monitoring of the effectiveness of

cancer control measures such as primary prevention, screening programmes, treatment

patterns, and health care quality; of assessment of the impact of differences in access to

diagnosis and treatment between geographical areas or social groups, in order to create

programmes for reducing health inequalities;

Clinical and translational cancer research.

The completeness and validity of data, and data quality is key for cancer registries assuming

their roles. Data from screening programmes is one of the important inputs for cancer

registries.

At international level, countries have been cooperating under the aegis of the International

Association of Cancer Registries. At EU-level, it is the European Network of Cancer

Registries (ENCR), operational since 1990, that promote collaboration between cancer

3
registries, defines data collection standards, provides training for cancer registry personnel

and regularly disseminates information on cancer incidence and mortality in Europe.

Fig. 1: Distinguishing screening from early diagnosis according to symptom onset

(WHO Guide to Cancer Early Diagnosis 2017)

The ENCR aims at improving the quality, comparability and availability of cancer incidence

data; creating a basis for monitoring cancer incidence and mortality in the EU; providing

regular information on the burden of cancer in Europe; and promoting the use of cancer

registries in cancer control, health-care planning and research. Its full membership is open

(upon the fulfilment of other, well-defined criteria) for population-based cancer registries, i.e.

registries that collect data on all new cases of cancer occurring in a specified population in a

defined geographical area. ENCR is affiliated to the International Association of Cancer

Registries; it is supported by the Commission, and its secretariat is hosted at the Joint

Research Centre.

Prevention is the most cost-effective public health strategy in NCD control (WHO, 2007).

Effective interventions to successfully prevent some cancers exist, but have not been fully

implemented. Tobacco control remains a high priority as articulated in the WHO Framework

Convention on Tobacco Control. Vaccination against human papillomavirus (HPV) and

vaccination against hepatitis B virus are very cost-effective interventions for cervical and

4
liver cancer prevention, respectively. Strategies to address other risk factors, including

physical inactivity, obesity, harmful use of alcohol, indoor and outdoor air pollution and

exposure to known occupational and environmental carcinogens need multisectoral action

and prioritization. (Sankaranarayanan et al., 2005).

This project work focus on the current state of breast cancer mortality and the need for

improved early detection and treatment strategies, particularly in low-resource settings. This

includes examining factors like late-stage presentation, limited access to systemic therapy,

and the effectiveness of different early detection methods (e.g., mammography, clinical

breast exam, self-breast exams). The study would also explore the role of healthcare

providers in promoting early detection and the potential impact of interventions like

educational programs and increased access to screening and treatment.

1.2 Statement of the Problem

Cancer is a group of heterogeneous diseases that can affect almost any part of the body and

has many anatomic and molecular subtypes, each requiring specific diagnostic and

management strategies. Approximately two thirds of global cancer deaths are in less

developed countries, where case fatality rates are higher due to late-stage presentation and

less accessible treatment. The consequences of delays in care and advanced cancer are dire –

the likelihood of death and disability from cancer increases significantly as cancer progresses.

It is therefore critical to identify barriers to timely diagnosis and treatment and to implement

programmes that provide access to care for all. Early diagnosis aims at reducing the

proportion of patients who are diagnosed at a late stage. It is particularly relevant in cases of

cancers of the breast, cervix, mouth, larynx, colon and rectum, and skin. This research is

aimed at early detection and treatment of cancer in adult female.

5
1.3 Research Questions

This study will help to profile solution to the following questions:

1. What are the most effective screening methods for early detection of cancer in adult
females, considering factors like age, risk factors, and accessibility?
2. How can screening programs be optimized to improve participation rates and reduce
disparities in access?
3. What is the role of novel biomarkers in improving the accuracy and sensitivity of
early cancer detection?
4. What are the primary barriers that prevent adult females from seeking timely cancer
diagnosis and treatment?
5. How do socioeconomic factors (e.g., income, education, insurance status) influence
access to cancer screening and treatment?
6. How can healthcare providers improve communication and education to empower
women to seek timely care?
7. What are the specific barriers faced by women in rural or underserved areas regarding
access to cancer screening and treatment?
8. What are the most effective treatment strategies for different types and stages of
cancer in adult females?
9. How can treatment protocols be personalized to improve patient outcomes and
minimize side effects?
10. What are the long-term survival rates and quality of life outcomes for women treated
for different types of cancer?
11. What are the most effective strategies for promoting cancer awareness and prevention
among adult females?
12. How can public health campaigns be tailored to address specific risk factors and
cultural beliefs?
13. What is the role of lifestyle factors (e.g., diet, exercise, tobacco use) in cancer
prevention?
14. What are the unique challenges and opportunities for early detection and treatment of
breast cancer in younger women?

1.4 Purpose of Study

The purpose of this study on early detection and treatment of cancer focuses on detecting
symptomatic patients as early as possible so they have the best chance for successful
treatment. This is because when cancer care is delayed or inaccessible there is a lower chance
of survival, greater problems associated with treatment and higher costs of care.

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1.5 Aim and Objectives

Aim

The aim of this research is to promote and create more awareness, on early detection and

treatment of cancer in adult female.

Specific objectives

To achieve the aim of the study, the following specific objectives, will be considered;

i. To develop and implement a comprehensive screening program for early detection

of cancer in adult females.

ii. To educate and raise awareness among adult females about the importance of

regular cancer screenings.

iii. To provide access to affordable and high-quality screening tests for early detection

of breast, cervical, and ovarian cancer.

iv. To ensure timely referral and treatment for females diagnosed with cancer.

To collaborate with healthcare providers, hospitals, and community organizations to

streamline the screening and treatment process.

1.6 Justification of The Study

This research will help to provide more information about cancer, and how to detect and

diagnose it at the earlier stage. This research will also help to create more awareness that will

reduce late discovery of cancer which leads to the casualty many individuals, especially

among low income earners in the societies today. This research will also look into the

importance of early detection and treatment of cancer in adult female.

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1.7 Scope of The Study
The study involves the early detection and treatment of breast cancer in adult females, it
encompass a range of activities, from raising awareness about preventative measures and
screening to improving access to timely and effective treatment. This includes strategies for
early detection (screening and diagnosis), advancements in treatment modalities, and
addressing barriers to care.

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 CHAPTER TWO

2.0 Literature Review

2.1 Cancer Detection and Treatment

Cancer is a group of heterogeneous diseases that can affect almost any part of the body and

has many anatomic and molecular subtypes, each requiring specific diagnostic and

management strategies. Comprehensive cancer control consists of core components –

prevention, early diagnosis and screening, treatment, palliative care and survivorship care –

that should be addressed in detail by a national cancer control plan (NCCP), evaluated

through a robust monitoring mechanism that critically includes cancer registries and is

founded on integrated, people-centered care (WHO, 2015; 2002).

Tumor markers have been used for decades in oncology. Tumor markers are biomarkers

found in blood, urine, cerebrospinal fluid, or other body tissues that are elevated in

association with cancer. Tumor markers can, in theory, be used for screening, diagnosis,

staging, or disease monitoring. However, to date, many tumor markers have demonstrated

poor accuracy and effıcacy, particularly among the most prevalent cancers. To understand

biomarkers and other tests employed for earlier detection of new or recurrent cancer, one

needs to understand a number of epidemiologic concepts (Porta MA, 2014).

9
Figure 2. Overview of Implementation Phases for Early diagnosis and Detection
Pathways.

δ) Pathology services as the basis for breast cancer diagnosis. (*) Regardless of age or
domicile. (**) Some middle-income countries introduce clinical breast examination (CBE)
combined with mammography to reduce mammography intensity or as stand-alone test for
expanded age groups £) Systematic screening offered to women attending health services
for any reason, including response to media campaigns promoting breast cancer early
detection €) Definition of number of visits in the clinical pathway (one to three): screening,
complementary studies, diagnosis. (ϕ) Organized screening as opposed to opportunistic
screening. As early detection programs are successfully implemented, early diagnosis
services need to be continually supported for all women.

2.2 Screening Test

Simply defıned, screening is the use of a test among individuals with a population risk for or

higher probability of cancer in order to detect that cancer sooner (secondary prevention) or

10
prevent its complications (tertiary prevention). Rarely, a screening test is used to prevent

cancer (primary prevention), such as the Papanicolaou (Pap) test to fınd precancerous cellular

changes in the cervix. When screening is used to monitor for cancer recurrence, the term

surveillance is commonly used instead. For screening to be effıcacious, a number of

conditions are necessary.

The cancer should be an important cause of morbidity and mortality. A proven, safe, and

acceptable test should exist to detect early-stage disease. The natural history of the cancer

should be understood. The cancer should have a recognizable latent or early asymptomatic

stage. In the absence of intervention, all or most cases in a preclinical phase should progress

to a clinical phase. Pseudo cancer, or even over diagnosis of a benign cancer that would never

progress, can be problematic in this situation. Safe and effective treatment must be available.

Screening in both healthy and high-risk populations offers the opportunity to detect cancer

early and with an increased opportunity for treatment and curative intent. Currently, a defined

role for screening exists in some cancer types, but each screening test has limitations, and

improved screening methods are urgently needed. Unfortunately, many cancers still lack

effective screening recommendations, or in some cases, the benefits from screening are

marginal when weighed against the potential for harm. Here we review the current status of

cancer screening: we examine the role of traditional tumor biomarkers, describe

recommended imaging for early tumor surveillance, and explore the potential of promising

novel cancer markers such as circulating tumor cells (CTC) and circulating tumor DNA.

Consistent challenges for all of these screening tests include limited sensitivity and

specificity. The risk for overdiagnosis remains a particular concern in screening, whereby

lesions of no clinical consequence may be detected and thus create difficult management

decisions for the clinician and patient. If treatment is pursued following overdiagnosis,

11
patients may be exposed to morbidity from a treatment that may not provide any true benefit.

The cost-effectiveness of screening tests also needs to be an on-going focus.

2.3 Breast Cancer Imaging

In 2014, over 235,000 new cases of breast cancer were diagnosed in the United States and

over 40,000 deaths attributed to the disease.( Siegel et al.,2014) Several guidelines exist for

screening for early detection of breast cancer in the average risk, asymptomatic general

population. Breast self-examination starting in the third decade of life can be considered part

of screening for breast cancer, although clinical breast examination by a health care provider

every 3 years is essential. Some organizations discourage breast self-examination because of

the risk for increased biopsies and lack of evidence of benefıt. Women should be advised to

report any breast changes to their health care provider (Segel, et al., 2014).

Breast cancers are easier to treat, and outcomes are often better when they are detected and

treated early. Breast cancer screening can identify cancers early and is a vital approach to the

control of this cancer. The Minnesota Cancer Reporting System (MCRS) and Sage Screening

Program are working together to reduce racial and ethnic disparities in breast cancer

mortality. MCRS is a statewide, population-based cancer reporting system that gathers and

reports on cancer occurrence to support state and local cancer prevention and control

programs.

Mammography plays a crucial role for early detection of breast cancer. Pace and Keating

published an outstanding review that includes a systematic assessment of mammography

benefıts and risks (Pace & Keating, 2014). Based on over 50 years of published evidence,

they concluded that regular mammography screening reduces breast cancer mortality by 19%

(nearly 15% for women in their 40s and 32% for women in their 60s).10 However, the

cumulative risk for false-positive results is extremely high at over 60% for a woman who

receives 10 years of annual mammograms in her 40s to 50s, and this can lead to increased

12
anxiety, biopsies, and medical expenses.( Pace & Keating, 2014; Elmore & Kramer,

2014)The starting age and frequency of mammography must be balanced with an individual’s

risk for breast cancer and an awareness of a high likelihood of false positive fındings. ( Pace

& Keating, 2014; Elmore & Harris, 2014; Elmore & Kramer, 2014; Weedon-Fekjaer,

Romundstad & Vatten, 2014).

Mammography guidelines have been proposed by various organizations with clear overlap,

but also clear distinctions. Each organization recommends at a minimum that women

between the age of 50 and at least 70 should receive mammography at least every 2 years

(with consideration of annual screens by some groups starting at age 40). (Siegel R, Ma J,

Zou Z, et al., 2014; Nelson HD, Tyne K, Naik A, et al.,2014) When discussing this topic with

patients, Pace and Keating10 suggest to highlight: (1) mammography is not a perfect

screening test, (2) mammography saves lives (fıve of 10,000 women age 40 to 49, 10 of

10,000 women age 50 to 59, and 42 of 10,000 women age 60 to 69), (3) mammography can

over diagnose and there is potential for false-positives (at least half of women undergoing

annual mammography will be incorrectly told they might have cancer over 10 years, and 20%

will require biopsy to prove it is not cancer), and (4) informed decision should rely on family

history, individual risk, preferences, and expert recommendations.

Mammography plus breast MRI in women who areBRCA1/ BRCA2 carriers offers

comparable survival benefıt with prophylactic bilateral mastectomy at age 25 and

prophylactic bilateral salpingo-oophorectomy at age 40. (Pijpe, et al., 2012) Sensitivity,

metastasis-free survival, and overall survival was higher in patients with familial breast

cancer treated with MRI compared with mammography-based screening for invasive cancer,

but not ductal carcinoma in situ.(Rijnsburger et al., 2010). Many guidelines now suggest

performing an annual MRI at age 25 and then alternating with, digital mammography

13
beginning at age 30 so that imaging of the breasts occurs every 6 months. (Bevers et al.,

2014; Lowry et al., 2012).

2.4 Protection from Breast Cancer

Although breast cancer cannot be prevented, the risks of developing breast cancer can be

minimized through specific preventive activities. These include changes in lifestyle, diet,

overall physical characteristics and obesity, and interventions for women at high risk of

developing breast cancer using tamoxifen and estrogen-like compounds.

The most important and beneficial protection activity is the early detection of breast cancer

(screening). Breast cancer is most easily and effectively treated in its early stages. Survival

rates drop dramatically when women present with advanced cases regardless of the setting;

therefore, a primary strategy for reducing breast cancer mortality is increasing the proportion

of cases that are detected during the early stages of the disease.

Unfortunately, women in resource-poor countries generally present at a later stage of disease

than women elsewhere, in part due to the lack of mass screening programmes. Regular

screening of all women over a certain age has the potential to sharply increase the proportion

of cancer cases that are diagnosed in their earliest stages.

There are a number of approaches to the screening of breast cancer.

Breast self-examination has been endorsed and widely promoted by cancer organizations and

authorities around the world. Its effectiveness, however, is dependent on education and

outreach among women, and upon conscientious and regular self-examination. Breast self-

examination should be used in combination with mammography and clinical breast

examination, and not as a substitute for either method. In fact, whether breast self-

examination alone can reduce the number of deaths from cancer is currently a source of

controversy.

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Clinical breast examination is one of the primary modes of screening for breast cancer. Its

effectiveness is dependent upon the skills of the health worker and the facilities available. It

is therefore important that health workers are fully and appropriately trained. Clinical breast

examination combined with mammography is considered essential to reducing mortality from

breast cancer.

Mammography is known to reduce breast cancer mortality among women, but its benefits are

dependent upon several factors such as the equipment used, the skills of the technician taking

the mammography and the expertise of the radiologist reading the mammogram. Other breast

imaging techniques include ultrasonography, computed tomography (CT) and magnetic

resonance imaging (MRI).

2.5 Colorectal Cancer Imaging

In 2014, nearly 140,000 new CRC cases were estimated to be diagnosed in the United States

and over50,000 deaths were attributed to the disease. Early CRC detection is known to

improve clinical outcomes with multiple iterations of surveillance trials throughout the past 4

decades. Adenomatous polyps represent precursors to CRC, and the National Polyp Study in

1978 demonstrated that their removal dramatically reduces CRC risk (WHO, 2016; WHO,

2017; WHO, 2016). Winawer et al later showed in a randomized clinical trial that

colonoscopy 3years after polyp removal was as effective as annual colonoscopy and urged a

3-year interval before colonoscopy after adenomatous polyp removal. In more recent years,

multiple population based studies using case control, cross-sectional, and cohort designs have

demonstrated that CRC risk and mortality are substantially reduced with regular colonoscopy

screenings with odds ratios and standardized mortality ratio ranging from 0.23 to 0.71 (WHO,

2007; WHO, 2014; Knaul, et al., 2015; Ibawi, et al., 2013; Azzani, et al., 2015; Ambroggi, et

al., 2015). Additionally, the protective effects of screening using colonoscopy was noted to

be more pronounced in the distal versus proximal colon (WHO, 2007; WHO, 2014; Knaul, et

15
al., 2015) [Link] now offer screening in the general population at 5-year

intervals beginning at age 50 and have begun discussing whether 10-year intervals could be

effective. The U.S. Multi-Society Task Force on CRC recently updated their guidelines to

recommend 10-year intervals for surveillance after negative screening in individuals at

average CRC risk (Barker G., 2007). The National Comprehensive Cancer Network(NCCN)

recommends screening for CRC at age 50 if the patient has no family history of CRC and no

personal history of adenoma or sessile serrated polyps (SSP), CRC, or inflammatory bowel

disease (Devi, et al., 2007) NCCN guidelines suggest screening for CRC using colonoscopy,

stool-based guaiac/immunochemical testing, or flexible sigmoidoscopy. Despite the

widespread adoption of colonoscopy for CRC screening, Samadder et al recently described in

a population-based study that 6% of all patients with CRC still developed interval tumors

within 6 to 60 months of colonoscopy (associated with higher rate of adenomas and CRC

family history). Three current randomized clinical trials in Europe and the United States are

now investigating screening for CRC using colonoscopy and comparing colonoscopy with

fecal immunochemical testing(or no screen) with10 - to 15-year CRC mortality. The reader is

referred to the following consensus update by the U.S. Multi-Society Task Force on CRC and

in-depth review article for excellent summaries of recent trials and discussion of CRC

surveillance.

2.6 Lung Cancer Imaging

In 2014, more than 224,000 people in the United States were diagnosed with lung cancer and

almost160,000 patients died from lung cancer, making it the deadliest adult cancer. As

imaging technology has advanced, so too has lung cancer screening and early detection using

annual low-dose CT (LDCT), which has led to both controversy and excitement in the fıeld

of early cancer detection. The National Lung Screening Trial (NLST) is the large randomized

clinical trial to be published. It demonstrated a 20% reduction in death in current or former

16
smokers. Six other lung cancer screening trials have been published or are ongoing.

(Detterbeck et al., 2013; Moyer et al., 2014). Several recent reviews and editorials, as well as

the current screening guidelines, summarize the benefıts and harms associated with LDCT

(Detterbeck et al., 2013; Moyer et al., 2014).

.Similar to breast cancer and CRC,several professional societies have offered overlapping,

but still distinct, recommendations and guidelines on screening for lung cancer (USPSTF,

American College of Chest Physicians/American Society of Clinical oncology, American

Association of Thoracic Surgeons, NCCN, American Cancer Society, and American Lung

Association) The majority of these organization recommend annual LDCT for high-risk

individuals, which includes patients who are age 55 to 79 with a more than 30 pack-year

smoking history, former smokers who have quit within the past 15years, or patients age 50 to

79 with more than a 20 pack-year smoking history who have additional risk factors. Many

cost effectiveness analyses are being modeled for the national adoption of LDCT as the

preferred method of screening for lung cancer in current or former smokers.

In one study, the heath care expenditures were estimated to reach $1.3 to $2 billion with 50%

to 75% screening uptake and $240,000 in additional costs to avoid one cancer death. The

authors argue that LDCT will prevent over 8,000 annual deaths from lung cancer, but they,

and others, recognize that careful cost-effectiveness analyses will be key to understanding the

true value of screening for lung cancer.

Nevertheless, the Centers for Medicare & Medicaid Services (CMS) recently announced that

Medicare will cover LDCT in current or previous smokers, a move strongly supported by the

American Lung Association. Similar to breast cancer, informed decision making—with

understanding of the high like-lihood for false-positives (one in fıve LDCT screening

examinations may detect false-positive results, with each LDCT test 20 times more likely to

17
yielda false-positive resultthan an actual lung cancer)—is key to initiating a lung cancer

screening program. (Detterbeck et al., 2013; Moyer et al., 2014).

2.7 Common Steps of Barriers to Early Diagnosis

FIG. 3:

STEP 1: AWARENESS AND ACCESSING CARE

The consequences of delaying presentation due to low cancer awareness or inability to access

care are that cancer symptoms generally progress to become more severe and disease more

advanced. This can also result in the development of acute, emergency symptoms. If cancer

symptoms progress to become more severe, then individuals may ultimately seek care

through an emergency route rather than primary care services, which results in worse overall

outcomes (Ellis, et al., 2012; NCIN, 2010).

Poor health literacy

Health literacy comprises the skills that determine the motivation and ability of individuals to

receive, gain access to and use information that is culturally and linguistically appropriate to
18
promote and maintain good health (WHO, 2013). Lack of awareness about cancer symptoms

is common and can result in prolonged symptom appraisal interval and significant delays in

seeking care. This is particularly relevant to cancers with vague symptoms and to childhood

cancers

Cancer stigma

Cancer as a diagnosis and cause of death may not be known in some settings. Where cancer is

known, fearful and fatalistic beliefs are common. Cancer stigma is a sense of devaluation by

individuals or communities related to cancer patients (WHO, 2013). Other societal norms that

are social, cultural, gender based or linked to the legal and regulatory environment also

impact health-seeking behaviour. Patients may be embarrassed about the symptoms or fear

the financial or personal impact of receiving care for cancer.

Limited access to primary care

Access to primary care is critical for early diagnosis by enabling a timely diagnosis. Barriers

to seeking primary care may be related to financial constraints, geographic/transportation

obstacles, time-poverty and inflexible working conditions, non-availability of services,

sociocultural or gender-related factors, compounded by generally lower health literacy and

higher levels of cancer stigma. Certain groups within a population may be less likely to be

able to access primary care services, particularly those from lower socioeconomic groups,

those with lower-level education, people with disabilities, indigenous populations or other

socially excluded groups (WHO, 2016). As a result, these groups are most likely to present

with emergency symptoms when cancer has already grown and often spread.

STEP 2: Clinical Evaluation, Diagnosis and Staging

The diagnostic interval may occur at one or multiple levels of care, depending on the site of

initial presentation and requires coordination among services including pathology and

radiology. Delays can arise at multiple points during this diagnostic interval and are generally

19
known as diagnostic delays. Inaccurate clinical assessment and delays in clinical diagnosis

(Rubin et al., 2015)

A cancer patient can enter the health system from many points e.g. primary care, reproductive

health, traditional healers, emergency centre, mental health, HIV care, dental care and patient

encounters with health-care providers can result in delays in care when they lack diagnostic

capacity or are isolated from the health system. Identifying patients with suspicion of cancer

can be a challenging task in the ambulatory or emergency setting. Cancer signs and

symptoms can be vague, non-specific or difficult to detect. In general, a significant

percentage of patients who present with symptoms suspicious for cancer will be found to

have a different cause of those symptoms that is, they will not have cancer (Robin, et al

2015). Additionally, primary care providers may see only a limited number of patients for

each cancer type. Finally, health care providers may lack physical exam skills or have

insufficient time to assess suspicious cancer symptoms, such as an inability to properly

perform a clinical breast exam fora breast lump. These factors can lead to misdiagnosis and

delayed detection. A larger percentage of countries do not have programs or guidelines to

strengthen the early identification of common cancers at the primary care level. For example,

less than 50% of surveyed countries have clinical pathways to facilitate the early diagnosis of

colon or prostate cancer in primary care (WHO, 2016).

Inaccessible diagnostic testing, pathology and staging

Barriers to or harms from diagnostic tests and pathology can range from inaccessible or

unavailable services to over-using tests, depending on resource availability. In all settings, the

quality of diagnostic tests and pathology is critical. An inaccurate diagnosis of cancer can

result in harmful, inappropriate and unnecessary care.

Diagnostic imaging can increase the diagnostic certainty but does not confirm the presence of

cancer. An accurate pathologic diagnosis is critical. However, there are significant gaps in

20
current pathology services. In 2015, approximately 35% of low income countries reported

that pathology services were generally available in the public sector compared to more than

95% of high-income countries (WHO, 2016).

Poor coordination and loss to follow-up

The facility where a clinical diagnosis is made may be different from where the biopsies

obtained, pathology reviewed and/or staging performed. Delays in cancer diagnosis may arise

due to poor follow-up, lack of referral pathways and fragmented health services. Less than

50% of low- and lower-middle-income countries currently have clearly defined referral

systems for suspected cancer from primary care to secondary and tertiary care (WHO, 2016)

STEP 3: Access to Treatment

Promoting early identification of cancer in the absence of appropriate access to treatment is

not only ineffective, but is also unethical. A significant percentage of patients who receive a

cancer diagnosis do not initiate or complete treatment due to various barriers that can include

an inability to afford care or fear of financial catastrophe, geographic barriers and anxiety

about cancer treatment (WHO, 2014; Knaul, et al., 2015).

Financial, geographic and logistical barriers

Basic cancer treatment consists of one or a combination of treatment modalities, including

surgery, systemic therapy and radiotherapy. In a significant number of countries, basic

treatment services are unavailable (WHO, 2016).

Fear of financial catastrophe is also a major cause of non-attendance for diagnosis, delay and

abandonment of treatment among patients with early cancer symptoms. Out-of-pocket

expenses can be significant for direct and/or indirect costs (e.g. meals, transportation, loss of

earnings) (WHO, 2014; Knaul, et al., 2015). Impoverished or low socioeconomic status

populations are at the highest risk of not receiving treatment for cancer. In some settings, as

21
much as 50% of cancer patients fore go treatment due to the inability to pay for care (Ilbawi,

Einterz &, Nkusu, 2013; Azzani M, Roslani AC, Su TT, 2015).

Patients may have to travel long distances to access a facility capable of providing cancer

treatment, and longer travel distance has been associated with late presentation (Ambroggi, et

al., 2015 ). Indirect, out-of-pocket costs and the time required to seek and navigate care can

be burdensome and function as disincentives to accessing timely, affordable treatment.

22
 CHAPTER THREE

3.0 Methodology

This chapter will include the research design, the population of the study, sample and
sampling techniques, method of data collection, and how the data will be presented and
analyzed. All these are necessary so that anyone who reads this project can understand how
everything was done clearly and simply.

3.1 Methods and Materials:

The methods and materials used for carrying out early detection and treatment of cancer in

adult females may vary depending on the type of cancer being screened for or treated.

However, here are some common methodologies that are frequently used in cancer detection

and treatment:

1. Screening tests:

2. Imaging tests:

3. Genetic testing:

4. Surgical tools and equipment:

5. Chemotherapy drugs:

6. Radiation therapy equipment:

7. Targeted therapy drugs:

8. Immunotherapy drugs:

It's important to note that the methods and materials used for cancer detection and treatment

are constantly evolving as new technologies and treatments are developed. It's essential for

healthcare providers to stay informed about the latest advancements in cancer care to provide

the best outcomes for adult female cancer patients.

3.2 Research Design

The design of this project research is based on descriptive survey. This means that the study
is based on asking people questions and collecting their opinions, experiences, and
23
knowledge about this research topic. It helps the researcher to describe what is happening
without trying to change anything. In this case, the research wants to find out how to discover
early detection and diagnosis of breast cancer and create awareness of how to prevent it from
spreading among adults female.

3.3 Population Study

The population study of this research includes randomly selected adults female both those
who have been diagnosed with breast lumps or cancer cases within Wukari metropolis. These
are the ones the researcher used to learn from, because they have real-life experienced about
cancer.

3.4 Sample and Sampling Technique

From the population selected, they will be the ones who will answer the questions. This
group is called the sample. The sampling method used is purposive sampling. This means the
researcher will only choose people who are known to have breast cancer cases and receive
there treatment. The reason for this is to make sure that the people answering the questions
truly have knowledge or experience with the topic.

3.5 Method of Data Collection

The main tool that will be used for collecting data is a structured questionnaire. This is a set
of written questions that will be given to the respondents to fill in. The questions will be
simple and straight to the point. They will focus on the person’s experienced during and after
the treatment of the cancer. The researcher may also ask some few people to explain more if
necessary.

3.6 Method of Data Analysis

After all the questionnaires are collected, the researcher will go through them and count the

number of people who gives similar or different answers. The data will be presented using

tables and percentages. This will make it easier to understand the results and draw

conclusions.

24
 CHAPTER FOUR

4.0 Results and Discussions

Data Presentation and Analysis

This chapter will help to present some of the answers that were collected through the

questionnaires. The information will be shown in tables so that it is easy to understand.

4.1 Presentation of Data

Table 1: Response to questionnaire received from 200 people within Wukari local

government of Taraba State.

CHARACTERISTICS PERCENTAGE

Pregnancy Status

Pregnant 80%

Not pregnant 20%

Family history of breast cancer

Yes 30%

No 70%

History of any breast disease

Yes 45%

No 55%

History of alcohol

25
 Yes 90%

No 10%

History of Contraceptives

Yes 20%

No 80

History of giving birth

Yes 85%

No 15%

Table 2: Age range and percentage of some people confronted with the questionnaire,

shown below;

AGE RANGE PERCENTAGE

20 -24 80%

25-29 75%

30-34 60%

35-39 55%

40-44 55%

45-50 45%

Some possible results of carrying out early detection and treatment of cancer in adult females

include:

26
Increased survival rates: Early detection allows for intervention before the cancer has a

chance to spread, improving the chances of successful treatment and a favorable outcome.

Decreased morbidity: Early treatment can often lead to less aggressive treatment options,

reducing the physical and emotional toll on the individual.

Improved quality of life: Early detection and treatment can help minimize the impact of

cancer on everyday life, allowing individuals to maintain a higher quality of life during and

after treatment.

Discussion points for carrying out early detection and treatment of cancer in adult females

may include:

The importance of regular screenings: Encouraging women to undergo regular screenings,

such as mammograms, Pap smears, and colonoscopies, can help detect cancer at earlier stages

when it is more easily treatable.

Access to healthcare: Ensuring that women have access to affordable and timely healthcare

services, including screenings and treatment, is crucial for early detection and successful

outcomes.

Education and awareness: Increasing awareness about the signs and symptoms of cancer, as

well as the importance of early detection and treatment, can help empower women to take

charge of their own health and seek medical attention when needed.

Support and resources: Providing support services and resources for women undergoing

cancer treatment can help them navigate the challenges of diagnosis, treatment, and recovery

more effectively.

Possible Results of Early Detection and Treatment of cancer in adults female:

Improved Survival:

Early detection and treatment allow for more effective and less invasive treatment

options, leading to a higher chance of survival.

27
Reduced Treatment Complexity:

Early-stage cancers often require less aggressive treatments, such as surgery or targeted

therapies, compared to late-stage cancers.

Better Quality of Life:

Early detection and treatment can minimize the long-term effects of cancer, including

side effects from chemotherapy and other treatments, and improve the quality of life for

the patient.

Discussion Points:

The Importance of Screening:

Regular screening, such as mammograms, Pap tests, and colonoscopies, is crucial for

detecting cancer at an early stage, when it is more treatable.

Overcoming Barriers to Access:

Barriers to access, such as financial constraints, lack of transportation, and cultural

beliefs, can prevent individuals from seeking early detection and treatment.

Ensuring Equitable Care:

Efforts to ensure equitable access to cancer screening and treatment are vital to improve

outcomes for all women, regardless of their socioeconomic status or geographic location.

Early Detection vs. Late-Stage Diagnosis:

Late-stage diagnosis often results in lower survival rates, greater treatment complexity,

and higher healthcare costs.

The Role of Primary Care:

Primary care physicians play a crucial role in educating patients about cancer screening

and providing referrals to specialists for early detection and treatment.

Public Awareness and Education:

28
Public awareness campaigns can help to increase knowledge about cancer screening,

encourage early detection, and address misconceptions about cancer.

The Role of Technology:

New technologies, such as multi-cancer early detection tests, may offer new avenues for

early cancer detection.

29
 CHAPTER FIVE

5.0 Conclusion and Recommendations

In conclusion, cancer is one of the most devastating diseases; however, raising awareness and

encouraging action can empower people to protect their health and detect cancer early.

A plan for early detection of cancer is a key component within an overall cancer control plan.

It enables cases to be detected at an earlier stage, when treatment is more effective and there

are greater chances of cure.

A cancer screening programme is a far more costly and complex undertaking than an early

diagnosis programme. Therefore, where resources are limited, and where the majority of

cases are diagnosed in late stages, early diagnosis of the most frequent cancers, linked to

appropriate treatment, is likely to be the best option to reduce premature deaths and suffering

due to cancer.

Early detection programmes need to be linked to the provision of palliative care services. As

an early diagnosis or screening programme evolves, fewer patients will be diagnosed in

advanced stages. This is particularly true for a screening programme. However, even with the

best screening programmes, some patients will present with late stage cancer because of a

lack of adherence to the programme or failure of the screening method. All of these patients

will require palliative care.

Hence, it will be necessary for several decades to develop or reinforce early diagnosis and

screening programmes to reach the older population of women who already have acquired

persistent HPV infection.

To prevent cancer or find it early, focus on lifestyle changes, regular screenings, and staying

informed about cancer risks. Healthy habits like avoiding smoking, maintaining a healthy

weight, eating a balanced diet, and getting regular exercise can significantly reduce your

30
risk. Early detection through screenings and prompt medical attention can also increase the

chances of successful treatment.

5.2 Recommendation

Eat healthy foods. Eating healthy foods isn't a sure way to prevent cancer. ...

Stay at a healthy weight and be physically active. ...

Protect yourself from the sun. ...

Get vaccinated. ...

Stay away from risky behaviours.

Get regular medical care.

Don't use tobacco. Smoking has been linked to many types of cancer.

31
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