Olalekan Olasehinde, Department of Surgery, Obafemi Awolowo University
Kathleen A. Lynch, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
Anya Romanoff, Memorial Sloan Kettering Cancer Center and Icahn School of Medicine at Mount Sinai
Nigerian women are frequently diagnosed with breast cancer at late stages. In most cases, mastectomy without reconstruction is the surgical treatment offered for cure. This tends to take a heavy emotional and psychological toll on a predominantly young population of women. The fear of mastectomy and its consequences is one of the reasons for late presentation and non-adherence to treatment among Nigerian women.
Our group identified this as a potential area for intervention and took steps to address this gap. As a starting point, we sought to understand the psychosocial impact of mastectomy on affected Nigerian women. In our search for a validated tool to use, we found none that had been translated to any Nigerian language. The BREAST-Q, which is a widely accepted instrument that has been translated into many languages and used worldwide to measure patient-reported outcomes (PROs) following breast cancer surgery, had not been previously translated to any language in sub-Saharan Africa. We therefore saw the need for a linguistically and contextually appropriate instrument to measure PROs following breast cancer surgery in Nigeria. We embarked on the translation of the BREAST-Q into Yoruba, which is one of the three major Nigerian languages.
The translation process for the BREAST-Q is well-outlined and clearly defined by the BREAST-Q development team in a Guide for Translation and Cultural Adaptation of the Q-Portfolio Questionnaires. However, following this translation guidance in Nigeria came with several challenges, some of which were unanticipated. First was the need to identify a native English speaker who could also back translate into Yoruba language. This was a very difficult task as it required identifying a native English speaker who was also sufficiently conversant in Yoruba language, and had expertise and availability to conduct back translation and transcreation. This challenge was overcome by collaborating with faculty at the Institute of African Languages at the Obafemi Awolowo University, who provided a link to a British professor of African anthropology who had lived in Nigeria and studied Yoruba language for several years. Her contribution to the translation process was of immense value.
We also encountered challenges finding appropriate translations for some of the words used to describe the different characters of pain, such as nagging, sharp, throbbing and discomfort that are used in the BREAST-Q. This required interaction with the BREAST-Q team to appreciate the intent of each of the words. These meetings resulted in the coinage of expressions which depicted the intended meanings of the words, not just a literal translation.
Despite these challenges, we successfully completed the translation process. Assessment of the psychometric properties of the translated tool showed moderate to excellent performance in most aspects. We intend to utilize the lessons learnt during this process in translating the BREAST-Q into the two other major Nigerian languages: Hausa language in the North, and Igbo, which is the indigenous language in the South-Eastern part of Nigeria.
Following the translation, we proceeded to the next phase of our study which entailed the use of the translated questionnaire for assessing the impact of mastectomy on a cohort of Nigerian women across three Nigeria tertiary hospitals. This will be the first report of the use of this translated tool in sub-Saharan Africa, and the first use of any BREAST-Q instrument in Nigeria. Findings from our study are being considered in the design of pre-operative and post-operative interventions to address the impact of mastectomy on Nigerian women.
It is our expectation that the availability of this tool in a native Nigerian language will stimulate more research focusing on patient-reported outcomes among patients who have undergone surgery for breast cancer.
For further information, view the full journal article here.
This newsletter editorial represents the views of the author and does not necessarily reflect the views of ISOQOL.
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