Student Midwives’ Perspective on Improving Early Diagnosis in Breast Cancer During Antenatal Care

Abstract

Purpose The incidence of breast cancer in Uganda is estimated at approximately 32.3 per 100,000, with a 5-year survival rate of 56%. Breast cancers present later and have a higher incidence in patients in the child-bearing age group compared with those in high-income countries. Uganda has an ongoing program to train degree-level midwives for extended midwifery roles that are exclusive to practice in Uganda. These midwives are highly motivated and have intimate local knowledge and effective access to the female population with the highest incidence of breast cancers. This work assesses their views on the key reasons women present so late and ideas for system-strengthening measures that will target these reasons, effectively combining antenatal care with breast lump education and diagnosis. Methods Midwifery students in years at Lira University were invited to fill out a questionnaire—with two open and seven structured questions—that was handed out at the ends of lectures and collected the next day. Results One hundred fifty-three questionnaires were returned. In the open question, midwifery students indicated overwhelmingly that the main reason women present late is ignorance. Finance was perceived to be the second factor. Analysis of the stratified question demonstrated that, even with knowledge of breast cancer, women would still be likely to think that a breast lump does not matter, and this factor scored higher than finances, culture, or access to health care. Of respondents, 73% felt that a facility for diagnosis in the community would definitely help women come for treatment. As midwives, 94% would definitely refer a breast lump to a specialist breast clinic if one was available, and on a background of limited health care funding, 90% still felt that time and money should be prioritized toward breast cancer education diagnosis and treatment because of its impact on the community. Conclusion Community midwives are well placed to educate women on breast care in antenatal clinics. This questionnaire demonstrates their perspective on the overriding significance of educating the child-bearing population about breast lumps in addition to cancer education. Therefore, breast lump examination and diagnosis is being taught to the students, community diagnostic facilities are being developed alongside antenatal care (ultrasound and cytology), and a breast lump referral clinic is planned for the new hospital. AUTHOR’S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the author.