Research Article: Barriers to early presentation and diagnosis of breast cancer among African women living in sub-Saharan Africa

Date Published: February 13, 2017

Publisher: Public Library of Science

Author(s): Cynthia Pomaa Akuoko, Ernestina Armah, Theresa Sarpong, Dan Yedu Quansah, Isaac Amankwaa, Daniel Boateng, Anna Sapino.


Breast cancer (BC) has been described as the leading cause of cancer deaths among women especially in the developing world including sub Saharan Africa (SSA). Delayed presentation and late diagnosis at health facilities are parts of the contributing factors of high BC mortality in Africa. This review aimed to appraise the contributing factors to delayed breast cancer presentation and diagnosis among SSA women.

Five databases encompassing medical and social sciences were systematically searched using predefined search terms linked with breast cancer presentation and diagnosis and sub Saharan Africa. Reference lists of relevant papers were also hand searched. Quality of quantitative and qualitative articles were assessed using the National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the Critical Appraisal Skills Programme (CASP) quality appraisal checklist. Thematic analysis was used to synthesize the qualitative studies to integrate findings.

Fourteen (14) quantitative studies, two (2) qualitative studies and one (1) mixed method study merited inclusion for analysis. This review identified low knowledge of breast cancer among SSA women. This review also found lack of awareness of early detection treatment, poor perception of BC, socio-cultural factors such as belief, traditions and fear as factors impacting African women’s health seeking behavior in relation to breast cancer.

Improving African women’s knowledge and understanding will improve behaviors related to breast cancer and facilitate early presentation and detection and enhance proper management and treatment of breast cancer.

Partial Text

Incidence and mortality rates for cancer has increased over the second half of the 20th century and are likely to continue to surge substantially according to World Health Organization (WHO) projections [1]. In 2012, the world health cancer report estimated an unprecedented 14 million new cases and 8.2 million cancer related deaths, with the figure expected to rise by almost 70% over the next 2 decades [2]. Breast cancer is now the most common cancer both in developed and developing regions with around 690,000 new cases being diagnosed annually in the developed regions and around 92,000 in Africa [3]. BC is the leading cause of cancer death in females’ worldwide [4]. It accounted for 14% of the total cancer deaths in 2008. Although BC is the leading cause of cancer deaths in females worldwide, the fatality rates tend to be higher in economically developing countries. The incidence of breast cancer in Ghana is estimated to be 25 cases per 100,000 population compared to 93 per 100,000 in the USA. However, mortality is 12 per 100,000 in Ghana compared to 15 per 100,000 in the USA [5]. There is evidence of emerging disparity in long-term mortality trends, with mortality rising in parallel with incidence in some countries yet declining in others despite rising incidence rates [6]. In developed countries, although incidence rates are high for BC, death rates have been decreasing over the past 25years [7]. A lot of factors might account for this growing disparity between the economically developed and developing countries.

This review sought to identify health seeking behaviors and other contributing factors to delays in BC detection among African women. We identified knowledge gap as an important contributing factor for late presentation and early detection measures. Knowledge is an important determinant of healthcare utilization and this association has been previously established. Studies also reveal that this barrier to BC treatment and management is not only evident among African women but also in other developed countries including UK, USA, Canada, Hong Kong and India where an association between poor knowledge and health literacy with late detection of BC and case presentations persist [44–48].

Generally, knowledge inadequacy of BC and its early detection measures continue to be one of the most important factors in determining women’s attitude towards BC screening and treatment. Understanding the benefits of early detection and presentation of BC among women was poor across all studies. Sources of information, knowledge of early detection measures, sociocultural beliefs and traditions revealed women’s perceptions of BC. Societal traditions and beliefs play an important role in women’s BC perceptions, screening measures and treatment. The findings of this study prompt educational campaigns among African women to enhance their knowledge of BC, benefits of early detection and treatment.




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