In Uganda, Family Obligations Hinder Breast Cancer Care, Education

By Mary Henderson

In the sub-Saharan African country of Uganda, statistics on breast cancer are particularly sobering. The incidence of the disease has been increasing five percent every year for the last decade and a half, and the five-year breast cancer survival rate is just 56 percent, compared to more than 85 percent in North America.

"Cancer claims more lives in Uganda than HIV, tuberculosis and malaria combined and breast cancer is the second highest cause of cancer mortality," said Scott J. Parker, MD, a radiology fellow at the Huntsman Cancer Institute at the University of Utah.

During a Sunday session in the Learning Center, Dr. Parker discussed the results of a study designed to better understand the role family obligation stress plays in the breast health behavior of Ugandan women.

"Despite the fact that treatment for breast cancer is provided free of cost at the Uganda Cancer Institute, up to 89 percent of new breast cancer diagnoses present with stage III or IV disease," he said. "The average woman waits over two years after self-detecting a lump before seeking medical care."

Survey Shows Dire Need for Breast Cancer Education

To gather more data about Ugandan women and their breast health-seeking behavior, Dr. Parker traveled to Uganda with a team of researchers in 2016 to help administer the Breast Cancer: Attitudes on Surveillance and Knowledge (ASK) Survey.

"Ultimately the key to increasing breast cancer survival rates is early detection," Dr. Parker said. "Understanding what limits that early detection is valuable."

The survey was administered to 401 Ugandan asymptomatic women (ages 25–74) in both rural and urban locations. Of the respondents, 69 percent were employed full-time, 62 percent were married or living with a partner and the median household size was 5–6 people. More than half of the women surveyed reported never receiving breast cancer education and a third had never participated in preventative healthcare visits. The ASK Survey also included a multi-item scale to measure family obligation stress by asking women about the amount of time and resources they devote to family care and self-care—and the extent to which they are overwhelmed by the demands of family responsibilities.

Members of the Statistics Department at the University of Washington analyzed the ASK survey data to identify associations between family obligation stress and socio-demographic and economic factors with the women's breast health-seeking behavior, including gathering information and obtaining check-ups.

Results of the analysis revealed that family obligation stress increased with the number of children and adults in the home and full-time employment or student status, Dr. Parker said.

"Higher family obligation stress was associated with lower rates of receiving breast cancer education and less participation in preventive healthcare visits and contributes to delayed diagnosis of breast cancer among women in Uganda," said Dr. Parker. "We believe this may also be true in other similar cultures."

Based on the results, Dr. Parker said future clinical interventions should consider the effect of family obligation stress by providing education in locations other than the medical clinic, such as the workplace, churches and schools.

"Educational efforts could be targeted at schools, where mothers are picking up their children," he said. "HIV/AIDS campaigns did a good job of targeting their message to schools. If teenage girls are educated on breast cancer, by the time women reach their 30s and 40s, breast care would be more familiar to them."