Breast cancer awareness and downstaging practices among adult women in the Gulu City Main Market, Northern Uganda: A cross-sectional study

Abstract Background: Breast cancer (BC) is one of the most common cancers that occur worldwide among women. There were more disability-adjusted life years (DALYs) lost to breast cancer among women worldwide than any other cancers, and DALYs occurred in women globally after puberty, with increasing rates later in life. Improvements in breast cancer survival began in the 1980s in countries where early detection programs combined with different modes of treatment to eradicate the invasive form of the disease were practiced. Recent data showed that there was a higher prevalence of breast cancer among women in Northern Uganda than among women in the rest of Uganda.The objective of this study was to determine factors associated with breast cancer awareness, breast self-examination (BSE), clinical breast examination (CBE), and other modalities for screening and early breast cancer detection among adult women in the Gulu main market.Methods: A cross-sectional study was conducted in the Gulu main market in 2020. A total of 98 adult women were recruited for the study by a random sampling method. The questionnaire had an internal validity of Cronbach’s α=0.72. The study was approved by a local IRB. SPSS version 26.0 was used for data analysis, and a p-value less than 0.05 was considered significant.Results: Most participants were 20-29 years 41(41.8%), married 44(44.9%), monthly incomes of >UGX1 million shillings 51(52.2%), Acholi 81(82.7%), Catholics 46(46.9%), vendors 75(76.5%), duration of work in the market (1-10 years) 64(65.4%), primary level of education 39(39.8%), and had 1-2 pregnancies 37(37.8%). The independent factors associated with breast cancer awareness, breast self-examination, and clinical breast examination were vendor (primary occupation) (β=-0.130, t=-2.979, p<0.004), duration of work in the market (1-10 years) (β=-0.186, t=-2.452, p<0.016), and higher level of education (β=-0.091, t=-2.506, p<0.014).Conclusions: Breast cancer awareness and downstaging practices in adult women in the Gulu main market were thought-provoking. Women with better socioeconomic status (higher education, moderate work duration in the market and primarily vendors) in the Gulu main market were more likely aware and practiced breast cancer downstaging activities. There is a need to strengthen publicity on breast cancer-related knowledge for lower-income occupational groups and those with lower education levels to better understand the importance of conducting BSE, CBE, and mammography for early breast cancer detection.