Breast cancer screening pathways in Ghana: applying an exploratory single case study methodology with cross-case analysis

Adwoa Bemah Boamah Mensah; Kofi Boamah Mensah; Raymond Akawire Aborigo; Varsha Bangalee; Frasia Oosthuizen; Nuworza Kugbey; Joe-Nat Clegg-Lamptey; Beth Virnig; Shalini Kulasingam; Busisiwe Purity Ncama

doi:10.1016/j.heliyon.2022.e11413

Breast cancer screening pathways in Ghana: applying an exploratory single case study methodology with cross-case analysis

Heliyon. 2022 Nov 8;8(11):e11413. doi: 10.1016/j.heliyon.2022.e11413. eCollection 2022 Nov.

Affiliations

¹ Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Ghana.
² Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Ghana.
³ Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, University Road, Durban, South Africa.
⁴ Navrongo Health Research Centre, Navrongo, Ghana.
⁵ School of Natural and Environmental Sciences, University of Environment and Sustainable Development, Somanya, Ghana.
⁶ Department of Surgery, School of Medical Sciences, University of Ghana, Ghana.
⁷ College of Public Health and Health Professions, University of Florida, USA.
⁸ Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA.
⁹ Discipline of Nursing, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Howard Campus, University Road, Durban 4001, South Africa.

Abstract

Background: Breast cancer is steadily increasing in Ghana, with the majority of Ghanaians only seeking care in the advanced stage of the disease. Furthermore, structured breast cancer control strategies are mostly non-existent. This study aimed to examine breast cancer and breast screening pathways in a tertiary healthcare facility within the Kumasi metropolis.

Method: We used a single exploratory case-study design to purposefully select one healthcare facility as a case with embedded sub-units of analysis (patients, first-degree relatives of patients, and clinicians) to address the study's aim. In-depth interview was used to generate evidence from 35 participants. Applying Miles and Huberman's thematic strategy, a cross-case analysis was conducted using Morse's analytical framework.

Results: Five (5) main themes emerged from the data: description of breast cancer, breast health education in Ghana, breast screening practices among women, the state of breast screening and barriers to breast screening uptake and lastly, the way forward. Malignancy of the breast was described as common, especially among young women who commonly present with advanced disease with poor prognostic outcomes. There were reports of limited breast cancer awareness and knowledge among women. Comparatively, urban educated women were noted to be relatively knowledgeable and more proactive about breast cancer than the less-privileged women in rural communities. Self and clinical-breast examination practices were reported as unusual habits for Ghanaian women. Several provider-related factors, lack of screening facilities, and attitude of women were highlighted as barriers to breast screening practices. Education among health professionals and interventions to promote opportunistic and organized breast screening were cited as the way forward for breast cancer control and early detection in Ghana.

Conclusion: This is a confirmatory result of a stark burden of breast cancer in Ghana, inferring a need to address the deficiencies around breast cancer and early detection practices.

Keywords: Breast cancer; Case study; Cross-case analysis; Ghana; Screening pathways.

Associated data

figshare/10.6084/m9.figshare.19091999