A greater understanding of the nature and drivers of poor breast cancer (BC) awareness in sub-Saharan Africa (SSA) will inform much needed awareness programmes. We aimed to assess the level and nature of BC awareness in the multi-country African Breast Cancer—Disparities in Outcome (ABC-DO) cohort of women newly diagnosed with BC during 2014–2017. Awareness indicators were assessed during a baseline interview at/near diagnosis. Logistic/ordinal regression was used to estimate odds ratios (OR) for indicators of BC awareness in relation to woman-level characteristics for individual settings and then meta-analyzed. In the 1,451 women included, almost all Namibian non-black women (n = 104) knew of BC and its curability, while in Namibian black and Zambian women, one in 7 (~ 15%) had not previously heard of BC and 25–40% did not know it was curable. In Uganda and Nigeria awareness was lowest: one in four women had no BC awareness, and 2 in 3 had no knowledge of its cure potential. Low educational level, unskilled employment, low socioeconomic position, rural residence, older age, being unmarried, and in some settings HIV-positivity, were associated with lower BC awareness—e.g., having unskilled employment was associated with not having heard of BC (summary OR 3.37; 95% confidence interval (CI) 2.17–5.23), believing that it is incurable (2.43; 1.81–3.26), and not recognizing a breast lump symptom (1.85; 1.41–2.43) but with between-setting variation (I2 > 68% for all). The findings provide evidence of the level and difference in BC awareness and beliefs across different settings, highlighting the urgent need for context-specific education programmes in the SSA region.
Breast cancer Awareness Beliefs Symptoms Sub-Saharan Africa
African Breast Cancer—Disparities in Outcomes (study)
Human immunodeficiency virus
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The authors thank the women who participated in this study. They also thank the dedicated team of research assistants, notably Johanna Pontac, Allen Naamala, Agnes Kaggwa, Anne Nteziryayo, Teopista Nakazibwe, Chris Sule Oyamienlen, Kingsley Iwuoha, Esther Ezeigbo, Mildred Lusaka, and Mirriam Mudolo.
ABC-DO is supported by the Susan G Komen for the Cure Foundation (IIR 13264158 to IARC and as part of “Implementing breast cancer care efficiency in Zambia through specialized health provider training and m-health evaluation of patient outcomes” for the Zambian site) and by IARC.
Compliance with ethical standards
Conflict of interest
The authors declare no potential conflicts of interest.
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