Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
National Center for Radiotherapy and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana.
Oncologist. 2018 Dec;23(12):1446-1452. doi: 10.1634/theoncologist.2017-0409. Epub 2018 Jun 29.
Breast cancer is the leading cause of cancer mortality among women globally. Most women in Ghana present with advanced stage disease. The aim of this study is to characterize sociocultural factors associated with delayed presentation.
Qualitative study (grounded theory, constant comparative method) using individual in-depth interviews with breast cancer patients seen at the Korle Bu Teaching Hospital in Accra, Ghana. Interviews were conducted in English and three local languages. We achieved theoretical saturation with 31 participants.
The mean length of delay reported by patients was approximately 1 year. Five recurrent themes were related to delayed presentation: (a) Women with a confirmed breast cancer diagnosis delay treatment because of the fear of mastectomy due to self and societal stigma; (b) role of the church as a social support system given the societal stigma associated with breast cancer; (c) study participants expressed some awareness of breast cancer, but with varying depths of breast cancer knowledge encompassing both myths and misconceptions about breast cancer; (d) most patients present late because they do not associate a "painless" breast lump with possible breast malignancy; and (e) delayed presentation linked to significant financial burden associated with breast cancer treatment.
Despite current efforts to increase breast cancer awareness, the fear of mastectomy remains one of the main reasons for delayed presentation. Successful breast cancer education programs will need to be framed within the broader sociocultural dimensions of femininity that address some of the stigma associated with mastectomy reported in the Ghanaian context.
Most women in Ghana present with advanced-stage disease. The aim of this study was to characterize sociocultural factors associated with delayed presentation. Although several quantitative studies have been conducted on delays in presentation in sub-Saharan Africa (SSA), this study is one of the few to identify fear of mastectomy as a reason for delayed presentation. Anecdotal data from current clinical experiences in SSA suggest that this is still an issue that has not been adequately reported and addressed in most SSA countries. The research results presented here will hopefully guide health providers and national organizations in designing breast cancer education programs in Ghana and other parts of SSA.
乳腺癌是全球女性癌症死亡的主要原因。加纳大多数女性就诊时已处于晚期。本研究旨在描述与延迟就诊相关的社会文化因素。
采用个体深入访谈法对加纳阿克拉科勒布教学医院就诊的乳腺癌患者进行定性研究（扎根理论、恒定比较法），访谈使用英语和三种当地语言进行。我们对 31 名参与者进行了理论饱和。
患者报告的平均延迟时间约为 1 年。有五个反复出现的主题与延迟就诊有关：（a）因自我和社会对乳腺癌的污名化，确诊乳腺癌的女性会因害怕乳房切除术而延迟治疗；（b）鉴于社会对乳腺癌的污名化，教会作为社会支持系统发挥作用；（c）研究参与者对乳腺癌有一定的认识，但对乳腺癌的知识深浅不一，包括对乳腺癌的一些神话和误解；（d）大多数患者就诊较晚，因为她们不会将“无痛”的乳房肿块与可能的乳腺癌联系起来；（e）与乳腺癌治疗相关的重大经济负担导致了延迟就诊。
尽管目前正在努力提高乳腺癌的认识，但对乳房切除术的恐惧仍然是延迟就诊的主要原因之一。成功的乳腺癌教育项目将需要在与加纳背景下报道的乳房切除术相关的一些污名化相关的更广泛的社会文化维度内制定。
加纳大多数女性就诊时已处于晚期。本研究旨在描述与延迟就诊相关的社会文化因素。尽管已经在撒哈拉以南非洲（SSA）进行了几项关于就诊延迟的定量研究，但本研究是为数不多的确定对乳房切除术的恐惧是导致延迟就诊的原因之一的研究之一。来自当前 SSA 临床经验的传闻数据表明，这仍然是一个在大多数 SSA 国家尚未得到充分报告和解决的问题。这里呈现的研究结果有望为加纳和 SSA 其他地区的卫生保健提供者和国家组织设计乳腺癌教育计划提供指导。
