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Structural And Sociocultural Barriers To Breast Reconstruction In Sub-saharan Africa
Natalie M. Guzman, BA1, Brigit D. Baglien, MD
1, Blair Richards, MPH
1, Ishmael Kyei, MBBS
2, Paa Ekow Hoyte-Williams, MBBS
2, Mahteme Bekele, MD
3, Mary E. Byrnes, MUP, PhD
1, Sarah T. Hawley, PhD
1, Adeyiza O. Momoh, MD
1.
1University of Michigan, Ann Arbor, MI, USA,
2Komfo Anokye Teaching Hospital, Kumasi, Ghana,
3St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Purpose: Breast cancer is the leading cause of cancer-related mortality in sub-Saharan Africa (SSA). Women in high-income countries are more likely to undergo mastectomy when counseled about reconstruction options. We examined whether reconstruction availability would improve mastectomy acceptance in SSA and identified key barriers.
Methods: Cross-sectional survey study of women with breast cancer (Stage 0-III) from hospitals in Ethiopia and Ghana (2023-2025). Used multivariable log-binomial regression to examine associations between demographics and strongly agreeing barriers were relevant.
Results: Among 239 participants, 85% believed reconstruction availability would increase mastectomy willingness. Top barriers were insurance (90%), cost (89%), household obligations (86%), and travel (86%). In multivariable models, country was the primary predictor of strong barrier agreement, with Ghanian women more strongly endorsing structural barriers (prevalence ratio [PR] 3.30-6.83,
P<.001) (
Figure 1). However, for social support, marriage status was the primary predictor. Unmarried women were significantly more likely to strongly agree it was a barrier (PR 1.89,
P=.028). In unadjusted comparisons of "strongly" or "somewhat agree," Ethiopian women more frequently cited sociocultural barriers such as culture or religion (>98% vs <60%,
P<.001).
Conclusion: Most women believe reconstruction availability would improve mastectomy acceptance. Structural barriers were more prevalent in Ghana while sociocultural barriers were more prevalent in Ethiopia, suggesting the need for tailored approaches. Addressing these barriers is an important step towards improving the acceptance of oncologic surgical treatment.
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