Breast cancer is generally perceived by the populace as a death sentence, but contrary to this popular opinion, positive outcomes of treatment have been achieved by presentation in the early stages of the disease. Research has produced facts that this can be achieved by adopting a policy to include health education in secondary school curricula where breast self-examination (BSE) is taught to male and female students.

INTRODUCTION
Just like every other cancer, breast cancer is a disease in which there is an unregulated growth of cells, but this time they are the cells of the breast, a milk-producing gland located on the anterior chest wall. Breast cancer is not solely a disease for women alone, as men are also affected in 1.2% of cases, but the greater burden is on women of reproductive age (98.8%), with a mean age of 48 years [1].

Breast cancer is the most common cancer affecting women of reproductive age all over the world. The disease burden in a low- to middle-income country like Nigeria is alarming, despite concerted efforts by the government and various non-governmental organisations towards improving management outcomes. There has been a steady increase in the incidence of breast cancer in Nigeria, from 15.3 per 100,000 in 1976 to 33.6 per 100,000 in 1992 to 52.0 and 64.6 per 100,000 in 2012 in Ibadan and Abuja, respectively [1]. This is a result of a recent increase in women’s awareness and knowledge of breast cancer through health education programs [2].

OVERVIEW
Health education is a tool for health promotion. Health education programs include health awareness campaigns, mass media, seminars, workshops, and school health education programs, among others [2]. Breast self-examination (BSE) is taught during these programs and is done in an attempt for early detection to reduce mortality [2]. In 2007, the World Health Organization (WHO) pointed out that for education to be effective, it has to be culturally appropriated and targeted to the individual population [3].

A study by Asuquo, I. M. and Olajide, T. E. on the role of health education, carried out among 152 University of Calabar female graduates, formulated and tested three hypotheses using a validated instrument: an awareness and breast cancer disease reduction questionnaire. The study showed that breast cancer awareness significantly affected individual’s knowledge of symptoms and risk of breast cancer, as well as their practice of breast self-examination [2]. However, it’s sad to note that up to 80% of breast cancer cases in Nigeria are still in advanced stages, which leads to significantly high breast cancer mortality rates [4].

DISCUSSION
The government of Nigeria, in its commitment to the provision of quality health care for all its citizens, established through the Federal Ministry of Health a program called the National Cancer Control Plan [5]. This is an extensive cross-sectoral collaboration involving the government, academia, bilateral and multilateral organizations, and civil society to reduce the incidence and prevalence of cancer in Nigeria over the next 5 years and beyond, and we are actively working towards this vision [5].

Non-governmental organizations (NGOs) through various programs like Save a Breast Campaign (SABC) by Youth Health Action Network (YOHAN Africa), Breast Without Spots, Network of People Impacted by Cancer in Nigeria (NEPICIN), Pink Africa Foundation, and Leah Foundation, among others, have also made a significant impact on increasing breast cancer awareness and improving treatment outcomes in Nigeria.
Save a Breast Campaign (SABC) by Youth Health Action Network focuses on teaching young girls in secondary schools self-breast examinations. The program, which has benefitted 2600 students in 7 secondary schools in Enugu and Kwara states, Nigeria, received good uptake by the students who, in the post-surveys, admitted to having gained from the experience and were committed to continuing the practice.

Sadly, despite these efforts, presentation in the advanced stages of the disease appears to be daunting to the government and its collaborating NGOs, hence the need to push health awareness and education on breast cancer to the next level.

RECOMMENDATION
Given this present challenge, a recommendation to the government is to adopt a policy on the inclusion of health education in the curriculum of secondary school students, with an emphasis on teaching every student, both male and female, breast self-examination (BSE). We advocate that both boys and girls receive this education. This is because breast cancer also affects males, but most importantly, the males can also pass on the knowledge to their female family members and future spouses.
We encourage every NGO in Nigeria whose agenda is to improve the disease burden of breast cancer to advocate for the adoption of this policy.

REFERENCES
1. Julius GO, John AO, Joshua TI, Abidemi EO, Olusoga OA, Olufunso SA. Socio-demographic, pattern of presentation, and management outcome of breast cancer in a semi-urban tertiary health institution. The Pan African Medical Journal, 2020; 36:363. [doi:10.11604/pamj.2020.36.363.17866]

2. Asuquo IM, Olajide TE. The role of health education on breast cancer among University of Calabar female undergraduates. Journal of Education and Practice, 2015; 6(24): 151-161. https://files.eric.ed.gov/fulltext/EJ1078866.pdf

3. WHO (2007). Cancer Control: Knowledge into Action: A WHO Guide for Effective Programs: Early Detection. https://apps.who.int/iris/bitstream/10665/43743/1/9241547338_eng.pdf

4. Omisore AD, Olasehinde O, Wuraola FO, Sutton EJ, Sevilimedu V, et al. (2023) Improving access to breast cancer screening and treatment in Nigeria: The triple mobile assessment and patient navigation model (NTC05321823): A study protocol. PLOS ONE 18(6): e0284341. https://doi.org/10.1371/journal.pone.0284341

5. Nigeria Cancer Control Plan: 2018-2022. https://www.iccp-portal.org/system/files/plans/NCCP_Final%20[1].pdf