Understanding women’s perspectives on breast cancer is essential for cancer control: knowledge, risk awareness, and care-seeking in Mwanza, Tanzania

BACKGROUND: Breast Cancer is the most common cancer in women worldwide. Since 2008, Mwanza, Tanzania, has worked to provide comprehensive cancer services through its Zonal consultant hospital. New national guidelines focused on clinical breast exam requires that women be aware of and seek care for breast concerns. Therefore, this study aims to understand breast cancer awareness in Mwanza and describe women-level barriers, care-seeking behavior, and perspectives on breast cancer. METHODS: A community-based survey was administered to conveniently sampled women aged 30 and older to assess women’s perspectives on breast cancer and care-seeking behavior. RESULTS: Among 1129 women with a median age of 37 (IQR: 31–44) years, 73% have heard of cancer and 10% have received breast health education. Women self-evaluated their knowledge of breast cancer (from 1-none to 10-extremely knowledgeable) with a median response of 3 (IQR: 1–4). Only 14% felt they knew any signs or symptoms of breast cancer. Encouragingly, 56% of women were fairly-to-very confident they would notice changes in their breasts, with 24% of women practicing self-breast examination and 21% reporting they had received a past breast exam. Overall, 74% said they would be somewhat-to-very likely to seek care if they noticed breast changes, with 96% noting severity of symptoms as a motivator. However, fear of losing a breast (40%) and fear of a poor diagnosis (38%) were most frequent barriers to care seeking. In assessing knowledge of risk factors, about 50% of women did not know any risk factors for breast cancer whereas 42% of women believed long term contraceptive use a risk factor. However, 37% and 35% of women did not think that family history or being older were risk factors, respectively. CONCLUSIONS: The success of efforts to improve early diagnosis in a setting without population-based screening depends on women being aware of breast cancer signs and symptoms, risks, and ultimately seeking care for breast concerns. Fortunately, most women said they would seek care if they noticed a change in their breasts, but the low levels of cancer knowledge, symptoms, and common risk factors highlight the need for targeted community education and awareness campaigns.