Low Rates of Early Detection Drive Excess Breast Cancer Mortality in Underserved Communities Audio Journal of Oncology Podcast

BRIGHTON, UK—In underserved communities throughout the world low rates of early breast cancer detection are key drivers of mortality, according to the findings of research from Uganda, the United Kingdom and Nigeria. A range of low cost community-based interventions could be used to modify these drivers, the research concludes.
Huge reductions of breast cancer mortality in underserved communities could be achieved by prioritizing early detection, according to lead author Deborah Ikhile PhD, from the Brighton and Sussex Medical School at the University of Brighton in Sussex UK, who discussed the implications of her findings with the Audio Journal of Oncology’s Peter Goodwin at the Royal Society of Medicine’s 2023 Tackling Inequalities conference.  This could be achieved—even where costly mass screening was not possible—by health education delivered through existing social and cultural structures that were presently being overlooked or ignored, her study concluded.
“Breast cancer is beyond an individual disease,” said Dr. Ikhile. “Doctors, researchers, clinicians, decision-makers need to have in-depth understanding of the social determinants that influence a woman’s ability to present early or not.”
Her group’s five-year survey with structured interviews among women in rural and semi-rural communities of Uganda had concluded that ‘structural violence’ was a root cause of late breast cancer detection.
This consisted of multiple disservices to women, unintentionally perpetrated through inappropriate medical care structures. Poor health education plus myopic national, global and donor priorities, all combined with negative attitudes to women, and a failure to engage with the well-established grass-roots local organizations in the community.
According to Dr. Ikhile, existing local services and social infrastructures could be harnessed to turn around breast cancer detection.
The present-day two-fold excess of mortality from breast cancer among most black African women everywhere (as compared their white counterparts in privileged communities) could largely be eliminated by effective early detection.  It was necessary to overcome factors such as stigma, misogyny, fear and gender prejudice from the global level downwards.  She believed Uganda was not exceptional and that the findings were relevant to cancer detection in underserved communities everywhere.
Dr. Ikhile’s interest in getting to the bottom of breast cancer inequalities began when she was still living in Nigeria and had (what turned out to be) a benign breast lump. Because she had access to private medicine her parents were able to get prompt diagnosis, followed by surgical excision. But this sensitized her to the plight of millions of women in low-resourced communities who did not have access to private health care.
The research in Uganda sought to identify the challenges and barriers to breast cancer detection and to investigate how these issues could be addressed within a primary care context.
The findings showed that cancer in Uganda was beyond individual control. “What came out is that, beyond your lack of knowledge, your lack of awareness, beyond fear, beyond attitude: Other factors, like community support, primary care services, even the clinician’s pressures, all these factors come into play, and support us to look at a holistic view to breast cancer detection,” Dr. Ikhile said. The survey also found that even after eventual detection of breast cancer there was often no easy access to follow-up care and services.
The whole agenda surrounding campaigns such as the Early Detection Saves Lives initiative had been flawed, as these had often centered around victim-blaming—making it seem as though the women were responsible for not detecting breast cancer early. But this was not a reality for most women, according to Dr. Ikhile. “The reality for women is th