The findings of this study show that participants had high knowledge score on various aspects of breast cancer. This is not the usual pattern among health care workers particularly nurses in developing countries. A previous study  reported poor knowledge of breast cancer risk factor among nurses in Karachi, Pakistan. Another study in Morocco  reported that only 43% of the nurses in their study had good knowledge. Similarly a study among teachers in Saudi Arabia reported limited knowledge of breast cancer .
In Nigeria various studies among nurses have also depicted low level of knowledge. A study among female health care workers reported that only 9.8% of nurses in their study had good knowledge of risk factors of breast cancer . Another study  among female health care workers reported that although 14% of the whole group had excellent knowledge only two nurses, (1%) of the study population had excellent knowledge while 43% had poor knowledge. Furthermore another study  reported that “breast cancer and breast self-examination practices among nursing students were relatively high, 97.3%”.
This current study however observed issues of concern as 40% of PHC nurses in this study considered pain as an early warning sign of breast cancer and only 20% correctly identified that a painless lump in the breast may be an early warning sign of breast cancer. In response to an unstructured question there were many wrong responses for EDM such as “diagnostic radiology”. There is a consensus in the literature that nurses play a very vital role in ensuring cancer information dissemination, screening and care as they have more frequent interaction with clients and their relatives . There is need that continuing education programmes for nurses on breast cancer and its early detection measures should examine critical areas to ensure that vital and correct information are communicated to clients. Such programmes should be consistent and structured to ensure their effectiveness.
Majority of participants in this study considered early detection and prompt treatment as an advantage of regular BSE practice while a little more than half considered developing breast cancer as the danger of irregular or non practice of BSE practice. These views may not be shared among nurses in developed countries where organized National screening program made more efficient EDMs available. Screening mammography can detect lumps before they are palpable and if followed up by immediate and adequate treatment it reduces mortality ranging from 12 to 70%, . The efficacy of BSE as a screening method for breast cancer is however not established in the literature.
In previous studies in developing countries BSE is often the most acknowledged EDM as well as the most practiced. In this study BSE was the most acknowledged and most practiced of the EDMs. While less than half of the participants in this study claimed to practice BSE only about half of these performed it monthly in the past 12months. In a study among Jordanian nurses, low mean scores of EDM of breast cancer was reported but almost 90% practiced BSE. However only 18% practiced it monthly . Mammography is the least acknowledged and least utilized EDM. The same pattern has been reported among female health care workers in Lagos and Benin City in Nigeria [18, 21] and among female teachers in Saudi Arabia .
Many studies have reported nurses’ and health care workers’ knowledge of breast cancer and practice of its EDM. However there is dearth of information on nurses’ and health care workers’ professional role to clients in relation to breast cancer and it’s EDM. This study explored nurses’ conduct of CBE and Formal Planned Client Teaching (FPCT) of EDM. Findings as depicted in Figure 2 indicated that very few of the participants engaged in FPCT and “how to conduct BSE” was the most taught. The participants in this study demonstrated high level of knowledge but same was not transferred to their clients. Very few of the nurses conducted CBE but most of those who did were confident of their skill. When they discovered lumps appropriate steps were taken in referring the clients to doctors. If this practice is encouraged among health care workers especially nurses it would have both direct and indirect positive implications on early detection of breast cancer. It has been suggested that in the developing countries training should be extended to heath care workers  and not just be limited to the general public. Hence there is need to drive continuing education programmes on various aspects of breast cancer among Primary Health Care nurses whose focus of care is disease prevention and health promotion.
Socio-demographic characteristics of age, educational level and type of nursing school as well as professional qualification were not significantly associated with knowledge, practice or client teaching of breast cancer and EDM practices. Similarly a study among rural women  reported that in a group of rural women in Turkey there was no significant association between age groups and BSE practice. Furthermore, the authors reported that other studies have not found significant association between socio-demographic characteristics and BSE practice. However in a Singapore study  socio -demographic variables were not also significantly associated with BSE practice, but clinical experience with caring for a client with breast cancer was significantly associated with knowledge and practice.
In conformity with previous studies in Morocco  and Turkey , knowledge of breast cancer was a significant constant predictor of practice of EDM. In this study practice of BSE was also a significant constant predictor of client teaching, it is imperative therefore to integrate continuing education programs for nurses to ensure practice and client teaching. A national screening program is the ultimate. When this is put in place, nurses will be vital to its successful implementation. Nurses will have to utilize culture based strategies to ensure utilization as availability does not always ensure utilization because there are many factors that may hinder utilization as demonstrated in a previous study .