Session : Improving Survival worldwide: Towards the Global Breast Cancer Initiative
Bridging Primary Care and Oncology: Barriers and Facilitators for Early Detection and Referral of Breast Cancer in Ethiopia
SERBA E. 1,2, GIZAW M. 1,2, SHITA A. 2, ANBERBER E. 10, MEZGEBU A. 1,2, TESFAW A. 1,2, THEOPHIL MMBAGA B. 4,5, JOFFE M. 6, O'NEIL D. 7, JEDY E. 8, ABDELLA K. 9, ADDISSIE A. 1,2, KROEBER E. 2, KANTELHARDT E. 2,3, GETACHEW S. 1,2
1 Addis Ababa University, Department of Epidemiology and Biostatistics, School of Public Health, College of Health Science, Addis Ababa, Ethiopia; 2 Global and Planetary Health Working Group, Institute of Medical Epidemiology, Biostatistics and Informatics Martin Luther University, , Halle (Saale), Germany; 3 Department of Gynecology, Martin-Luther-University, Halle-Wittenberg,, Halle (Saale), Germany; 4 Kilimanjaro Clinical Research Institute,, moshi, Tanzania; 5 Department of Pediatric and Child Health, School of Medicine, KCMC University, moshi, Tanzania; 6 Strengthening Oncology Services Research Unit, University of Witwatersrand Faculty of Health Sciences,, Johannesburg, South Africa; 7 Yale Cancer Center, Yale University, , New Haven, CT, United States; 8 International Research Center of Excellence, Institute of Human Virology, , Abuja, Nigeria; 9 Ministry of Health , Addis Ababa, Ethiopia; 10 Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
Abstract Background: Breast cancer is a leading cause of cancer-related deaths in Ethiopia, accounting for an estimated 9,061 (22.6%) of all cancer-related deaths annually. Early stage I or II diagnosis stands at 34.2%, which is below the national or Global Breast Cancer Initiative (GBCI) target of 60% among newly diagnosed patients. Weak referral systems contribute to delays in detection. As primary healthcare facilities are the first point of contact for most women, identifying the barriers and facilitators to early detection at this level is critical. This study provides essential insights into primary care referral pathways to guide the implementation of national guidelines in alignment with global recommendations.
Objective:This study aims to assesses the barriers and facilitators for early breast cancer detection and referral pathways at the primary care level.
Materials and Methods: A qualitative exploratory study was conducted from April 01 to May 30, 2024. Data were collected through 12 in-depth interviews (IDIs) with health professionals, eight key informant interviews (KIIs), and three focus group discussions (FGDs) with women who came for breast cancer screening. Thematic analysis was used, with separate analysis for each group and method triangulation to identify convergent and divergent themes.
Results: Barriers to early detection and referral included low community awareness, financial and infrastructural constraints among both women and health facilities, and communication gaps, particularly insufficient feedback between referring and receiving facilities. Additionally, the perception of referrals as a stressful process and mistrust in the health system were found to be significant barriers. Facilitators included the commitment of health professionals to conducting clinical breast examinations, the availability of training, free clinical breast examination services and the launch of Ethiopia’s new national breast cancer guideline.
Conclusion: Strengthening early detection and referral at primary health care settings requires a multi-level approach, including raising awareness in the community, addressing financial constraints through strengthening community-based health insurance (CBHI), improving the availability of diagnostic services at public hospitals, improving inter-facility communication, and strengthening referral pathways. The new National Breast Cancer Guideline is a window of opportunity to address barriers at primary level care, a staged implementation including monitoring and evaluation may guide successful down-staging of breast cancer in Ethiopia.
Implication for policy and practice: Policymakers should prioritize raising community awareness about breast cancer; enhance communication and referral coordination between primary care and higher-level oncology services; and ensure that the free clinical breast examination services are linked to available diagnostic services to maintain a continuum of care.These are essential steps towards reducing delays, improving adherence to referrals, and supporting timely diagnosis. Such efforts are critical to meeting Ethiopia’s national breast cancer goals and the GBCI target of 60% early detection.