The effect of beliefs about breast cancer on stage and delay to presentation: results from a prospective study in urban South Africa

  • Sarah Rayne University of the Witwatersrand
  • K Schnippel University of Cape Town
  • S Grover University of Pennsylvania
  • D Kruger University of the Witwatersrand
  • C Benn University of the Witwatersrand
  • C Firnhaber University of the Witwatersrand
Keywords: Breast cancer, Barrier to care, Disparities, Surgery, Oncology

Abstract

Background: The disparity in breast cancer survival in Africa is often linked to poor education and awareness leading to late diagnosis and subsequent reduced survival. This study was designed to explore the relationship of attitudes and beliefs held regarding breast cancer to the stage and delay to diagnosis in South Africa. This study provies an epidemiological analysis of the spectrum of disease and outcomes of primary amputation for diabetic foot sepsis in a regional rural hospital.

Methods: Women attending an open-access breast unit over 14 months with newly-diagnosed breast cancer answered a survey regarding their fears and beliefs of breast cancer care. Questions addressed demographic, socioeconomic and educational factors linked to delay, and documented time taken to care. Odds ratio with 95% confidence intervals were calculated to identify factors associated with advanced stage at presentation and delay greater than six months.

Results: Of the 233 participants the median (IQR) age was 56 years (46–65). The most common stage at presentation was Stage 3 (55%), with 30.5% presenting with T4 tumour at presentation. Most women believed cancer could be beaten (90.0%), and their families would support them (92.8%). They disagreed that cancer was a curse (93.8%), punishment (90.5%) or that alternative therapies or traditional healing would cure their cancer (75.3% and 85.5% respectively). On univariate analysis, age under 45 years and transport difficulties predicted advanced stage at presentation. No socio-economic factors or beliefs increased the risk of delay to presentation.

Conclusion: Participants’ beliefs about their new breast cancer were most commonly appropriate, and showed a low level of fatalism, in contrast to other studies in Africa. Whilst raising awareness may be important, efforts to increase awareness alone may not directly prevent the likelihood of late or advanced diagnosis in this population.

Author Biographies

Sarah Rayne, University of the Witwatersrand

Department of Surgery, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

K Schnippel, University of Cape Town

Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

S Grover, University of Pennsylvania

Department of Radiation Oncology, University of Pennsylvania, Philadelphia, United States; and Princess Marina Hospital, Gaborone, Botswana, Botswana-UPENN Partnership, Gaborone, Botswana.

D Kruger, University of the Witwatersrand

Department of Surgery, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

C Benn, University of the Witwatersrand

Department of Surgery, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

C Firnhaber, University of the Witwatersrand

Clinical HIV Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Published
2019-03-29
How to Cite
Rayne, S., Schnippel, K., Grover, S., Kruger, D., Benn, C., & Firnhaber, C. (2019). The effect of beliefs about breast cancer on stage and delay to presentation: results from a prospective study in urban South Africa. South African Journal of Surgery, 57(1), 12-18. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/2704
Section
Oncology