1.1 Background to the study

Breast cancer is the major cause of mortality among women globally than any other form of cancer, Jemal et al. (2006). However, Daood (2017) notes that the statistics in Saudi Arabia where deaths associated with breast cancer stands at 19.8% at the age of 45 years which is a clear indication of the threat posed by the disease. Previously the disorder was believed to develop after women attained 45 years, but the dynamics are changing and young women are falling victims to the illness (Adebamawo, 1999). Detecting young women with breast cancer is very important because the illness at this age is more aggressive and victims rarely survive. According to Okobia and Okonofua (2006), clinical breast examination (CBE), mammography as well as breast-self-examination (BSE) serves as the three recommended screening methods for the disorder. Irrespective of their age, all women should be motivated to engage in BSE to help in limiting cases of mortality associated with breast cancer (Hackshaw & Paulo, 2003). The practice is considered imperative in enabling women to understand the structure as well as the composition of individual normal breasts thus helping to detect any abnormality (Plesnicar et al., 2004). Larkin (2001) asserts that there is a need for women to undergo BSE at least once monthly to enhance in limiting breast cancer risk.

There are lifelong benefits associated with promoting self-care, a path that is taken at a young age. For instance, if women are taught about breast self-care, it may serve in encouraging trends like BSE as well as seeking profession breast examinations on a regular basis (Ludwick & Gaczkowski, 2001). According to Budden (1995), engaging in health behaviors like BSE is a critical empowerment tool for women to enable them

to take responsibility and control of their health. BSE education and adhering to the exercise by young women helps in promoting healthy behaviors that serve as the basis for mammography as well as breast examination in later stages in life. Irrespective of the controversy surrounding the value of BSE, American Cancer Society (2013) and Hakama et al. (1995), recommends the practice as an option for breast self-awareness that may help in detecting the disease early.

Women derive benefits from BSE through gaining familiarity with the feel and appearance of their breast as well as the ability to detect any changes in the earliest time possible (American Cancer Society, 2013). The reason for support of continued BSE practice as a breast cancer screening process emanates from the ability of women to detect the disorder frequently on their own without the appearance of other symptoms (Levshin et al., 1998). Despite significant body of research regarding the disorder and BSE practice among females from 17 to 23 years, (Budden, 1995; Alsaif, 2004; & Budden 1999), very few studies have focused on information on the disorder and BSE practice for females in higher institutions of learning (Ludwick et al, 2001 & Milaat, 2000). Therefore, the current study intends to address the identified research gap. Scientific research has revealed that it is possible to prevent a third of all cancers and equally possible to cure a third others if diagnosed sufficiently. According to Parkin (1994) and World Health Organization (1997), these findings demand cancer control to be given priority in health programs, especially in the developing economies. In the quest to limit mortality incidents associated with the disease, an effective screening program must be put in place. This is best achieved through empowerment of female health workers as well as creating awareness amongst them about breast cancer screening programs. According to Nair and Nair (2005), any

measure that may help in preventing or identifying the disorder at an early stage is crucial towards saving lives and equally in improving health and wellbeing.

1.2 Statement of the Problem

WHO (2014) classifies breast cancer as the leading form of cancer among women from developed, middle-income, and third-world economies. Rates of the disease in middle-income and developing economies are on the rise due to urbanization. WHO (2014) asserts that mammography screening serves the only method that is effective, but it is applied in high resource settings. WHO (2014) further claims that there lacks evidence that supports the effect of BSE screening process.

However, some groups of researchers attribute the practice of BSE as essential in empowering women towards being responsible for their health. As such, engaging in BSE practice is imperative to raise awareness and pass knowledge among groups at risk of developing breast cancer as opposed to a screening method. According to the American Cancer Society (2014), BSE practice should be observed by women in their early 20s. In some countries, BSE is required to be conducted on a monthly basis. Examples of these countries comprise of Jamaica, Singapore, Mauritius, South Africa, and Namibia. In their study Wardle et al. (1995) surveyed female university students drawn from 20 European nations, the researchers revealed that 54% of the study respondents never engaged in BSE while 8 percent practiced on a monthly basis. In another study conducted by Shin et al. (20212) among university students in Korea, 27 percent of the study participants reported engaging in BSE practice. In other studies conducted among female university students 1.3% engaged in BSE monthly in Egypt (Boulos & Ghali, 2013), 36.7%-55.4% had engaged in BSE in Malaysia (Al- Naggar et al., 2013; Akhtari-Zaware et al., 2013), 19% engaged in BSE monthly in Nigeria (Gwarzo et al., 2013), and 17.4% in Yemen (Ahmed, 2010). According to Wardle et al. (1995); Ahmed, (2010); Shin et al. (2012) and Al-Sharbatti et al. (2013), some of the notable factors that serve as barriers to BSE comprised of poor attitudes towards the practice and lack of awareness.

Vorobiof et al. (2001) observed that South African physicians have realized an alarming rate of breast cancer incidents among young black women from 1998. What is even more worrying due to increased cases of the disease among young black women is that they have the lowest survival rate due to seeking healthcare when its already too late. The reason for delays before seeking healthcare professional services emanates from a tendency of the group to first seek consultation from traditional healers relating to lumps they experience in their breasts (Vorobi et al., 2001). Late diagnosis of breast cancer serves as the reason that subjects young women to lower survival rate as they have a tendency of seeking medical care when the disease is at advanced stages than their older counterparts.

Despite authorities recommending breast self-examination with an aim of limiting cases of breast cancer, BSE is still not widespread. Additionally, even with a quantifiable number of women possessing knowledge about the practice, and the resulting health benefits, they rarely practice it. In a study conducted by Pillay (2002), the researcher found out that one in five women was not aware of the disease, with half of them being unaware of its existence. The existing findings are imperative in the current research directed at the level of prevalence of breast cancer in Kenya.