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Added: Saulo Vento - Date: 18.12.2021 11:37 - Views: 19292 - Clicks: 950

Try out PMC Labs and tell us what you think. Learn More. 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. 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. 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 ]. Inthe world health cancer report estimated an unprecedented 14 million new cases and 8.

Breast cancer is now the most common cancer both in developed and developing regions with aroundnew cases being diagnosed annually in the developed regions and around 92, in Africa [ 3 ]. 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 Sub women sought breast cancer in Ghana is estimated to be 25 cases perpopulation compared to Sub women sought perin the USA.

However, mortality is 12 perin Ghana compared to 15 perin 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 for this growing disparity between the economically developed and developing countries.

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Variation in incidence rates may largely stem from greater availability of early detection measures as well as health seeking behaviors of women in developed countries [ 6 ]. Moreover, effective therapy may help lower BC death rates after detection [ 8 ]. Studies undertaken in Africa suggest low knowledge of breast and cervical cancer awareness [ 10 — 12 ].

This tends to impact on attitudes to uptake of screening resulting in late diagnosis in many women. Again, fatalism, fear, embarrassment, lack of trust in health services, lack of education has been cited as barriers to early presentation of the disease in African American women [ 13 — 16 ].

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These conditions affect not only the health and lives Sub women sought the women, but also their children, families, communities and the nation at large. Research stipulates that, early detection is an important determinant for better prognosis of several kinds of cancer including BC [ 17 ]. Furthermore, treatment of early stage BC is typically simpler and more cost effective than treatment of its advanced episodes [ 18 ]. Where healthcare resources are scarce, early detection positively impacts the delivery of BC treatment, that is, treatment in an earlier stage is likely to be less complex and more affordable [ 19 ].

The disparity in BC outcomes in women living in developing and developed countries provides the momentum for this paper to review research on barriers to early presentation and diagnosis of BC in women from Africa. This review is also relevant as barriers may not be limited to early presentation for BC alone. Findings from this review can potentially aid in drafting measures to improve the knowledge and health seeking behaviors of African women. This review was conducted with the aim to synthesize research evidences on the barriers to early presentation and diagnosis of breast cancer among women in sub-Saharan Africa.

A comprehensive search strategy was developed to find published studies on BC knowledge and health seeking behaviors of women in sub Saharan Africa. The sub Saharan region was classified based on the United Nations classification of countries [ 20 ]. The search strategy Appendix 1 was run in Medline then later adapted for, and run across selected relevant databases. Reference list of studies included in the review were hand searched along with titles and abstracts of African medical journals such as the South African medical journal, West African medical journal, East African medical journal and Central medical journal.

All studies identified during the search were assessed for relevance to the review based on the information provided in the title and abstract. For all papers that appeared to meet the inclusion criteria, a full report was retrieved. This was again assessed for applicability against the inclusion criteria in order to determine relevance to the review objective. Studies Sub women sought were included in this review were of any de qualitative and quantitative published in English language peer-reviewed journals, and primary research articles, that Sub women sought barriers to early presentation and diagnosis of BC in women of African descent living in Africa.

This included studies that explored knowledge of BC, studies of attitudes or barriers to breast screening, studies that explored attitude to and undertaking of breast self-examination BSE. Excluded articles consisted of those that included African women and women from other ethnic groups within the overall sample, but did not report on findings for the included ethnic groups separately.

Data were extracted systematically from all eligible papers through the use of standardized Data Extraction Forms DEFs developed by a research team [ 21 ]. Two standardized forms were used for qualitative and quantitative studies that merited inclusion in this review. Any disparities in prevalence data were resolved by consensus-based discussions among the authors.

Qualitative studies were appraised using different quality criteria [ 23 ]. Both extraction forms assessed the aims of the study, sampling procedure, data collection methods, analysis approach and limitations. The qualitative extraction form further assessed the level of critical self-reflection about biases and the extent to which findings from the study could be transferred to other settings or groups.

The quantitative form appraised the reliability, validity and generalizability of the quantitative papers. Findings from qualitative and quantitative articles were integrated into themes. Thematic synthesis of the qualitative studies [ 24 ] provides explicit and clear links between conclusions and the text of primary studies used in a review by ensuring rigor discussion of article content.

This enabled analytical abstraction of. Findings from the quantitative papers were absorbed within the themes using the multi-source synthesis method [ 25 ]. It also serves as a systematic guide in synthesizing data from their primary studies to give a meaningful and broad understanding of the subject.

The flow of information through the various stages of the review is represented in Fig 1. Seventeen 17 articles merited inclusion for this review. Out of these, 2 [ 2627 ] employed qualitative methods, one 1 mixed methods [ 42 ], whiles fourteen 14 were quantitative studies [ 28 — 343536 — 41 ] and were published from toFig 2. Nine 9 of the quantitative articles were descriptive cross-sectional surveys [ 29323335 — 384042 ] whereas 4 articles employed correlation methods [ 28303134 ]. The two remaining papers [ 3941 ] were quantitative surveys.

One of the qualitative articles involved the use of focus group discussion FGDs [ 26 ] to explore the knowledge and attitudes of BC and its early detection measures whiles the other used in-depth interviews. A total of participants were recruited and involved in the14 included quantitative studies. The least of participants in a study was women [ 31 ] and the largest consisted of participants [ 35 ]. One qualitative study [ 26 ] involved 6—7 participants in 4 focus group discussions. However, the total of participants involved was not reported whereas the other qualitative study recruited 12 participants for in-depth interviews.

A total of subjects participated in the mixed method study [ 42 ]. Sub women sought were recruited from both urban and rural settings with varied background characteristics. The ages of participants ranged from 18 to 91years.

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Several barriers to early presentation and diagnosis of BC were reported across all studies. Majority of the articles revealed limited knowledge of symptoms and risk factors of BC among study subjects. According to Gates, Lackey and Brown [ 43 ], a limited knowledge of breast cancer s and symptoms are generally associated with delayed presentation.

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The of our included studies indicate a strong association between knowledge of BC with delayed presentation among women with breast cancer. Ademola et al [ 35 ] reported Balogun and Owoaje [ 29 ] reported a majority Other barriers reported were limited knowledge of screening practices BSE, clinical breast examination [CBE], and mammography and varied misconceptions, misinformation and lack of information.

Some of the misconceptions include associating lump in the breast as cancer [ 28 ], BC attributed to evil spirit and infection [ 32 ], beliefs in folklore and myths regarding the causes of BC [ 41 ], fear of death upon diagnosis [ 27 ], belief that BC can be transmitted sexually, perception that BC affects only Caucasians, and the notion that BC has no cure [ 35 ]. Factors such as limited screening facilities in communities and poor health attitudes were also reported [ 27 Sub women sought, as barriers to late presentation.

Pace et al [ 40 ] presented of both individual and health system barriers that in late diagnosis and or treatment options for BC. Poor health seeking behavior as well as varied socio-demographic characteristics was not left out across studies as ificant barriers to BC diagnosis and treatment.

Majority of the participants involved in all included studies had little or no knowledge of mammography and BSE [ 30 — 3235424139 ].

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Knowledge on the benefits of early detection measures was also low among participants [ 262830 ]. Some studies showed that participants with higher educational attainment were more knowledgeable about BC issues than those with lower levels of education and or had no formal Sub women sought [ 3233 ]. Women in urban areas were more informed of BC than their colleagues in rural settings [ 283035 ]. Higher levels of education were also ificantly associated with BSE among respondents [ 2932 ].

BC information leaflets and physicians were the main sources of BC information in Okobia [ 32 ]. In contrast, studies conducted in Ghana and Tanzania [ 4142 ] indicated radio In [ 30 ], women obtained BC information from community elders, neighbors and friends Varied perceptions of BC were also reported across studies.

A large of participants perceived BC as very serious form of cancer [ 3034 ] or deadly [ 35 ]. In some studies, participants were reported to have the view that, African women were not susceptible to BC. Other studies reported that, respondents were of the view that BC is caused by infection, evil spirit and could be transmitted sexually [ 3235 ]. from qualitative studies, were not different from those of quantitative de. Studies reported that, participants were not convinced treatment could save women from losing their breasts or death [ 28Sub women sought32 ].

So I say anything that has no medicine is not good. In some studies, participants were reported to have believed that mastectomy was the only treatment for BC [ 31 ] whereas participants in others studies revealed that BC was nor curable [ 303235 ].

The review revealed poor health seeking behaviors among women in SSA and this influence the early presentation and diagnosis of breast cancer. Poor health seeking behaviors were as a result of socio-cultural factors, fear of being diagnosed cancer and death from cancer, as well as traditional practices, Table 3. A study, [ 26 ], revealed that low self-esteem and the awkward feeling of knowing one has a BC and its associated stigma causes trauma and thus deters most women from seeking healthcare when needed.

Some women were reported to have indicated that they prefer their health been a secondary issue than their families been stigmatized because of their BC status.

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In one study, This included fear of cancer diagnosis, fear of being examined by a physician and fear of being stigmatized if diagnosed positive. Participants indicated that the fear of mastectomy and death resulting from been diagnosed of BC prevented them from consulting their physicians or reporting at a health center [ 3132 ].

The fear, stigma and cost involved in diagnosis and treatment in Africa compels women to seek for alternative source of BC care including traditional healer and or herbalist. Pace et al. According to Pillay, [ 28 ] Okobia et al, [ 32 ] also reported that 8. The influence and dominance of traditional healers in rural African communities does not only act as a barrier to orthodox treatment but also in delay to seek treatment [ 27 ].

Socio-demographic characteristics such as age, marital status, women education and type of residence was reported as impediments to BC treatment. Age as a barrier to late presentation was described by [ 293339 ]. Maree et al [ 39 ] outlined the extent to which age and literacy were associated with screening Sub women sought.

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Bologun and Owoaje, [ 29 ], revealed that, awareness of SBE among years was Akhigbe and Omuemu [ 33 ] reported that BSE practice increases with age of participants;

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