Background
The African Breast Cancer Study (ABCS) is an ongoing multicentre cross-sectional study in Ghana investigating the relationships among metabolic syndrome (MetS), the gut microbiome, and breast cancer risk among women attending breast care centres. A total of 2,400 participants are being recruited and comprehensively assessed for socio-demographic, reproductive, hormonal, lifestyle, and dietary factors, as well as body composition, blood lipid profiles, stool-based 16S rRNA sequencing, and MetS diagnosis using the ATPIII criteria. Breast cancer cases are histologically confirmed, typed, and staged, and associations between MetS, gut microbiome diversity, and cancer subtype and stage are being evaluated. The findings will inform future prospective studies and support the establishment of an African Prospective Investigation into Cancers (APIC) to advance precision prevention, early detection, and cancer control in sub-Saharan Africa.

Objective
A comprehensive needs assessment was conducted to generate evidence on breast cancer awareness, care-seeking behaviour, access to services, psychosocial needs, and health system challenges in Ghana as a critical preparatory phase to participant recruitment for the ABCS study, to inform the design and implementation of the ABCS study, and to strengthen national breast cancer prevention and care strategies.

Methods
This qualitative study was conducted across six breast cancer care centres where the ABCS study is being carried out, between April and June 2025, among 180 participants: 60 health professionals, 60 patients/survivors, and 60 caregivers/relatives (10 per group per site), using Semi-structured interview guides. In addition, 12 focus group discussions were conducted (2 at each study site) - 6 with patients/survivors and 6 with caregivers. Data were analysed thematically using.

Results
Across health professionals, patients, and caregivers, community knowledge of breast cancer was limited and inconsistent, driven mainly by national annual monthly awareness campaigns held in October, rather than sustained education. Deep-rooted misconceptions—viewing breast cancer as spiritual, contagious, or inevitably fatal—along with fear of mastectomy and diagnosis, delayed symptom recognition, and care-seeking. Financial hardship was the dominant barrier, with unaffordable costs for transport, diagnostics, surgery, chemotherapy, and medicines, compounded by health-system constraints, including centralized services, limited diagnostic capacity (notably mammography), equipment shortages, long waiting times, fragmented referrals, and inconsistent counselling. Stigma and psychosocial distress were pervasive, marked by social avoidance, abandonment, emotional trauma, and high caregiver burden. Although pre-diagnosis understanding of diet and lifestyle risks was limited, many patients and caregivers adopted healthier behaviours post-diagnosis, increasing fruit and vegetable intake and reducing sugar, processed foods, and alcohol; however, structured nutrition and psychosocial support remained inadequate. Participants consistently called for continuous community education, decentralised and subsidised screening, mobile outreach, engagement of religious and traditional leaders, improved provider training, and strengthened patient navigation and support systems.

Conclusion/Implications
The needs assessment revealed major social, economic, and health-system barriers to effective breast cancer prevention, early detection, and treatment in Ghana, underscoring the need to embed community engagement, sustained education, decentralised and affordable screening, workforce strengthening, and integrated nutrition and psychosocial support within the ABCS study to enhance recruitment, retention, and long-term impact.