Recognising socio-cultural barriers while seeking early detection services for breast cancer: a study from a Universal Health Coverage setting in India

• Published in: BMC cancer Vol. 23; no. 1; pp. 1 - 881
• Main Authors: Sawhney, Riya, Nathani, Priyansh, Patil, Priti, Bhandarkar, Prashant, Veetil, Deepa Kizhakke, Venghateri, Jubina Balan, Roy, Nobhojit, Gadgil, Anita
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 19-09-2023; BioMed Central; BMC
• Subjects: Analysis; Breast cancer; Cancer; Care and treatment; Couples; Diagnosis; Health aspects; Hospitals; India; Investigations; Mammography; Medicin och hälsovetenskap; Mortality; National health insurance; Oncology, Experimental; Primary health care; Questionnaires; Screening barriers; Social aspects; Socioeconomic factors; Stigma (Social psychology); Universal health coverage; Wages & salaries; Womens health; India; Mumbai India
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-023-11359-3

Background Breast cancer is the commonest cancer among women in India, yet the uptake of early detection programs is poor. This leads to late presentation, advanced stage at the time of diagnosis, and high mortality. Poor accessibility and affordability are the most commonly cited barriers to screening: we analyse socio-cultural factors influencing the uptake of early detection programmes in a Universal Health Coverage (UHC) setting in India, where geographical and financial barriers were mitigated. Methods Two hundred seventy-two women engaging in an awareness-based early detection program were recruited by randomization as the participant (P) group. A further 272 women who did not participate in the early detection programme were recruited as non-participants (NP). None of the groups were previously screened for breast cancer. Interviews were conducted using a 19-point questionnaire, consisting of closed-ended questions regarding demographics and social, cultural, spiritual and trust-related barriers. Results The overall awareness about breast cancer was high among both groups. None of the groups reported accessibility-related barriers. Participants were more educated (58.09% vs 47.43%, p = 0.02) and belonged to nuclear families (83.59% vs 76.75%, p = 0.05). Although they reported more fear of isolation due to stigma (25% vs 14%, p = 0.001), they had greater knowledge about breast cancer and trust in the health system compared to non-participants. Conclusions The major socio-cultural barriers identified were joint family setups, lower education and awareness, and lack of trust in healthcare professionals. As more countries progress towards UHC, recognising socio-cultural barriers to seeking breast health services is essential in order to formulate context-specific solutions to increase the uptake of early detection and screening services. Keywords: Breast cancer, Universal health coverage, Screening barriers, India