Breast Cancer Beliefs as Potential Targets for Breast Cancer Awareness Efforts to Decrease Late-Stage Presentation in Uganda

Abstract

PurposeTo assess breast cancer beliefs in Uganda and determine whether these beliefs are associated with factors potentially related to nonparticipation in early detection.MethodsA survey with open- and close-ended items was conducted in a community sample of Ugandan women to assess their beliefs about breast cancer. Linear regression was used to ascertain associations between breast cancer beliefs and demographic factors potentially associated with early detection, including socioeconomic factors, health care access, prior breast cancer knowledge, and personal detection practices.ResultsOf the 401 Ugandan women surveyed, most had less than a primary school education and received medical care at community health centers. Most women either believed in or were unsure about cultural explanatory models for developing breast cancer (> 82%), and the majority listed these beliefs as the most important causes of breast cancer (69%). By comparison, ≤ 45% of women believed in scientific explanatory risks for developing breast cancer. Although most believed that regular screening and early detection would find breast cancer when it is easy to treat (88% and 80%, respectively), they simultaneously held fatalistic attitudes toward their own detection efforts, including belief or uncertainty that a cure is impossible once they could self-detect a lump (54%). Individual beliefs were largely independent of demographic factors.ConclusionMisconceptions about breast cancer risks and benefits of early detection are widespread in Uganda and must be addressed in future breast cancer awareness efforts. Until screening programs exist, most breast cancer will be self-detected. Unless addressed by future awareness efforts, the high frequency of fatalistic attitudes held by women toward their own detection efforts will continue to be deleterious to breast cancer early detection in sub-Saharan countries like Uganda.

Breast cancer early detection and diagnostic capacity in Uganda

“…VHTs and dispensary staff should be educated to recognize the signs and symptoms of breast cancer, to know the appropriate level of care for patient referral (currently level 5 or 6 until capacity is built at lower levels of the health system), and to deliver culturally appropriate health messages regarding breast cancer awareness to women 13‐16 . These efforts can be integrated into established systems; for example, prior research demonstrated the success of educational strategies in Uganda for improving outcomes for the management of infectious diseases.…”

Modifiable patient-related barriers and their association with breast cancer detection practices among Ugandan women without a diagnosis of breast cancer

“…Also, while many women believed that early detection would result in a cure, most believed by the time they self-detected symptoms it was too late. [14] These results, obtained in women without breast cancer, suggested multiple modifiable factors that could affect women’s participation in breast cancer detection practices. Simultaneously, these results seem to contradict the multiple barriers, not modifiable in the near term (socially determined barriers), Ugandan breast cancer survivors and others provided in prior studies (e.g., economic, social support) as possible reasons most women delay diagnosis or do not successfully complete the path to diagnosis.…”

Implementation of an Interactive Voice Response System for Cancer Awareness in Uganda: Mixed Methods Study

“…A study on prostate cancer in Uganda [ 12 ] found that only 10.3% of respondents had good knowledge of the symptoms. Low awareness, negative beliefs, and myths (eg, belief that cancer is caused by witchcraft) have also been reported for breast [ 13 ] and cervical cancer [ 14 ] in Uganda, contributing to low screening rates (4.8% to 30%) and late presentation (over 80% of patients presenting with advanced disease) [ 15 ].…”