Breast Cancer: Patient Awareness and Hormonal Status in Addis Ababa, Ethiopia

Summary: Background: Breast cancer is the leading cause of cancer in women worldwide with 2.3 million new cases and 685,000 deaths documented in 2020 (1). In Ethiopia, it is the leading cause of cancer morbidity accounting for one-third of all cancers among women and one in five of all cancers (2,3). Awareness about breast cancer risk factors, symptoms, diagnosis, and treatment is unknown. Methods: After Institutional Review Board’s approval, a descriptive questionnaire-based survey was done on patients recently diagnosed with breast cancer and presented to St. Paul’s Hospital Millennium Medical College Oncology Center from April 2021 to June 2022. A questionnaire consisting of 55 variables was prepared. Demographic data and general cancer information were collected from the patient charts. After obtaining informed consent, patients were interviewed with 33 questions related to the knowledge, symptoms, risk factors, early detection methods, and management options of breast cancer. The knowledge status was considered as “low,” “moderate,” and “high” if the scores fell in the range of 0–49, 50–79, and 80–100%, respectively. Descriptive statistics (mean, SD, frequency, percentage) and chi-square results were generated by using SPSS version 25. The level of significance was obtained at 0.05. Results: 96 patients (all females) fulfilled the inclusion criteria. The median age was 45 (25-87), and the majority 52 (53.8%) were in the age group between 25-49 years. More than half (51%) live in the capital, Addis Ababa. Almost two-thirds are married. Half of the participants are housewives and 31(32.3%) completed higher education. 79(82.3%) patients had at least one live birth with a median of 3 (0-8). 80.3% of the patients had breastfed with an average duration of two years. 13(13.5%) had a family member with breast cancer. Breast lump was the first symptom identified by 89(92.7%) patients, 77 (80%) could recall the time of presentation; and 32 (33.3%) went to see a health professional within 1 month of symptom onset. The most common histologic type was Ductal carcinoma in 74 (77.1%), and 34 (35.4%) had stage IV breast cancer at presentation. Hormonal status was available for 36 (37.5%) patients: 22 (61.1%) were ER-positive, 20 (55.6%) PR-positive, 16(44.4%) HER2 positive, 9 (9.4%) triple positive and 6 (6.3%) were triple negative. The total knowledge score is moderate with an average of 6.7 (out of 33 questions). There was a lack of knowledge about risk factors with an average risk factor score of 4.7 (low) out of 11 questions. The knowledge score for the symptoms of breast cancer was 6.2 out of 9 which is relatively better compared to the knowledge of risk factors. The knowledge score for treatment options and early detection methods was also low (5.8/13). Conclusions: Our study demonstrated that breast cancer patients coming to SPHMMC have a moderate level of knowledge about breast cancer symptoms but lack knowledge about risk factors, early detection methods, and treatment options for breast cancer.