Background:
Breast and cervical cancers are leading causes of cancer-related morbidity and mortality among women in low- and middle-income countries (LMICs), largely due to late presentation and limited access to early screening services. In Nigeria, screening uptake remains low due to poor awareness and the unavailability of screening services. Cultural beliefs, stigma, fear, and other psychosocial factors continue to shape women’s health-seeking behavior, particularly among socio-economically disadvantaged populations. Understanding these context-specific barriers is essential for designing effective, community-based screening interventions.
Objective:
This study explored how cultural beliefs, stigma, and psychosocial factors influence breast and cervical cancer screening uptake in Nigerian communities.
Methods:
This qualitative study was conducted between August and November 2024 in six purposively selected communities across three Nigerian states; Federal Capital Territory, Nasarawa, and Rivers. Data were collected through 60 in-depth interviews with key community stakeholders, including community leaders, religious leaders, women influencers, traditional healers, and policymakers, as well as 12 focus group discussions with adult community women. Semi-structured interview and discussion guides explored knowledge of breast and cervical cancer, perceptions of screening, decision-making processes, and perceived barriers and facilitators to early detection. Data were analyzed thematically using an inductive approach, allowing patterns and meanings to emerge from participants’ narratives.
Results:
Stigma emerged as a dominant influence on screening behavior, driven by fears of social embarrassment, discrimination, and perceived threats to marriage prospects. Misconceptions including beliefs that cancer is contagious, shame associated with visible symptoms or surgical scars, and the tendency to conceal illness were commonly reported. Fear was another major barrier, encompassing fear of a cancer diagnosis, invasive procedures such as mastectomy or hysterectomy, perceived inevitability of death following a cancer diagnosis, and mistrust of the healthcare system. As a result, some participants reported a preference for traditional medicine or avoidance of screening to mitigate emotional distress.
Decision-making around screening was often shaped by husbands, extended family members, and community norms, particularly in patriarchal and conservative settings. Privacy and modesty concerns, especially regarding exposure to male healthcare providers, further limited screening uptake in some communities. However, women influencers and supportive community structures played an important role in encouraging screening and reducing stigma.
Findings differed across stakeholders and states, highlighting the wide diversity of cultural practices, social norms, beliefs, and attitudes within Nigeria. These variations emphasize the importance of understanding local contexts, as approaches that work in one community may not be acceptable or effective in another.
Conclusion:
Cultural beliefs, stigma, fear, and psychosocial factors remain significant barriers to breast and cervical cancer screening in LMIC settings like Nigeria. Interventions should be culturally sensitive, community-driven, and tailored to local realities, with active involvement of community leaders, religious leaders, and women influencers. Addressing stigma, fear, and decision-making dynamics is critical to improving early detection and reducing cancer-related inequities.
 

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