A mixed-method assessment of beliefs and practice around breast cancer in Ethiopia: Implications for public health programming and cancer control

Abstract

A large proportion of breast cancer patients in Ethiopia present for biomedical care too late, or not at all, resulting in high mortality. This study was conducted to better learn of beliefs and practices among patients accessing breast cancer services in a large referral centre in Ethiopia. Using a mixed-method design, we interviewed 69 breast cancer patients presenting for care at Tikur Anbessa Hospital in Addis Ababa, Ethiopia, about their beliefs, experiences and perspectives on breast cancer. Awareness of breast cancer is low in Ethiopia and even among those who are aware of the disease, a sense of hopelessness and fatalism is common. Early signs/symptoms are frequently ignored and patients often first present to traditional healers. Breast cancer is perceived as being caused typically from humoral anomalies or difficulties resulting from breast feeding, and study participants indicate that stigmatisation and social isolation complicate discussion and action around breast cancer. Consistent with other studies, this study shows that traditional beliefs and practices are common around breast cancer and that numerous barriers exist to identification and treatment in Ethiopia. Integrating health beliefs and practice into public health action in innovative ways may reduce stigma, increase awareness and promote survivability among breast cancer patients.

What causes breast cancer? A systematic review of causal attributions among breast cancer survivors and how these compare to expert-endorsed risk factors

“…Despite the availability of information on breast cancer risk factors, eleven studies included in the review reported a number of women who indicated that they "don't know" the cause of their cancer when asked [9,14,16,[37][38][39][40]43,50,52]. It was found that 6-57% of women said that they did not know the Other factors, such as the socio-demographic background of participants in the included studies may have contributed to the variations in attribution prevalence observed.…”

“…Fifteen of the 24 included studies found that most women with breast cancer attributed their own cancer, at least in part, to family history or genetics [9,13,15,16,24,[34][35][36][37][38][39][40][41][42][43].Across the quantitative studies reviewed, the proportion of the sample in each study who reported that family history was a leading or sole cause of breast cancer varied. For example, in Costanzo et al's, [13] study, 70.5% (n=56) of the sample agreed that genetics or heredity was a leading cause.…”

“…Patients and survivors identify many different kinds of possible environmental causes for their breast cancer. A total of 15 of the 24 studies were reviewed and reported that women with breast cancer believed there was a connection between exposure to environmental toxins and their diagnosis [9,[13][14][15][16]24,[35][36][37][38][39][40][42][43][44]. In these studies, environmental toxins were defined as actions of other people (e.g., exposure to second-hand smoke), hazards found at the workplace, specific carcinogens, air pollution, exposure to chemical substances, toxic injury, and/or radiation.…”

“…God's will) are causes of breast cancer. A total of 15 studies reported that breast cancer patients viewed these factors as causal to their own breast cancer [9,13,14,16,35,36,[39][40][41][42][43]45,50,52,53] attributing their cancer to God's will meant a predetermined future in which cancer treatments would not be curative. They also expressed the stigma that they felt when a diagnosis of cancer was interpreted as "karma" or punishment for their sins by other people who live in their community.…”

“…Risk varies according to the number of relatives with breast cancer and the age at which relatives were diagnosed [30]. Gene linkage studies estimate that the BRCA 1 and BRCA 2 genes, explain between 2.0 and 9.0% of all breast cancers [30][31][32][33].In this review, a family history of breast cancer was one of the personal causes most cited by women.Fifteen of the 24 included studies found that most women with breast cancer attributed their own cancer, at least in part, to family history or genetics [9,13,15,16,24,[34][35][36][37][38][39][40][41][42][43].Across the quantitative studies reviewed, the proportion of the sample in each study who reported that family history was a leading or sole cause of breast [16,24,36,38,42]. In addition, breast cancer patients in six studies included in the review identified oral contraceptive pills as causal [16,24,36,38,40,42], which was identified by 1.5% (n=23)…”