"If diagnosed early, you will be stressed and die…" drivers for breast cancer screening services uptake among women in Dar es Salaam.

Abstract

Worldwide, there has been an increase in the breast cancer mortality rate, with disproportionately high rates in low and middle-income countries. Addressing breast cancer starts with early detection through screening services. In Tanzania, despite being among countries with high rates of breast cancer, screening services uptake has remained low. This study aimed to explore the drivers for breast cancer screening among women accessing health care services at a specialized cancer treatment hospital in Dar es Salaam, Tanzania. We adopted an exploratory case study employing qualitative techniques to analyze the drivers for breast cancer screening among women in Dar es Salaam. We interviewed four groups of respondents: women with breast cancer attending cancer treatment clinics, young women and old women without breast cancer attending cancer screening units, and older women who do not show up for breast cancer screening. From analysis of the in-depth interviews and focus group discussions we found that the drivers for breast cancer screening operate at different levels; individual as a centre of making the decision to be screened, family as an attribute to decide uptake of screening, the society drivers, the healthcare providers related drivers and health facility related drivers. These attributes were found to influence women's decisions to screen, and the possibility of uptake of breast cancer screening was dependent on family and social motivation. In most instances, women were driven to utilize breast cancer screening when the services were readily available at their neighbouring health facilities. The findings from this study have enlightened that people's decision about utilizing breast cancer screening services is based not only on perceptions of their risk but also on fellow community members who have survived the disease, the experiences of breast cancer screening services from their networks and the performance of healthcare institutions in delivery of such services. The use of breast cancer survivors' support groups to promote breast cancer screening services is advocated from the findings of our study.