Patient Factors Contributing to Late-Stage Breast Cancer Presentation

Abstract

Purpose To assess factors contributing to the late-stage breast cancer presentation in Uganda. Methods A survey with open and close-ended questions was conducted on a community sample of Ugandan women to assess 1. Breast cancer downstaging practices and breast health messaging preferences to present early for a CBE in the theoretical scenario of self-detecting a palpable lump (breast health messaging preferences) and 2. Their beliefs (culturally-perceived risks, scientifically-established risks, perceived benefits of early detection) about breast cancer. Results The 401 Ugandan women who participated in this survey were mostly poor with less than a primary school education. Of these women, 27% had engaged in BSE and 15% had undergone a CBE. Greater breast cancer downstaging practices were associated with an urban location, higher education, having a health center for their regular source of care and receiving breast cancer education (P<0.05). Women indicated a greater breast health messaging preference from their provider (66%). This preference was associated with a rural location, having a health center for their regular source of care, and receiving breast cancer education (P<0.05). Culturally-perceived risks of breast cancer were common (58.5-97.7%) and were described by the majority as the most important causes of breast cancer (69.2%), compared to scientifically-established risks (45.6-64.5%; 16.2%, respectively). Perceived benefits of early detection varied widely (12.3-70.3%) while many women held fatalistic attitudes towards their own detection efforts, including the common belief that cure is impossible once they could self-detect a lump (56.3%). Only having a lower income was associated with all breast cancer belief categories. Conclusion Current breast cancer education in Uganda is inadequate; most Ugandan women do not participate in breast cancer downstaging practices despite receiving breast cancer education. Misconceptions 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 towards their own detection efforts will continue to be deleterious to breast cancer early detection in sub-Saharan countries like Uganda.