title: Transforming breast cancer control campaigns in low and middle-income settings: Tanzanian experience with 'Check It, Beat It'.
abstract: Breast cancer incidence and mortality rates are similar in low resource settings like Tanzania. Structural and sociocultural barriers make late presentation typical in such settings where treatment options for advanced stage disease are limited. In the absence of national programmes, stand-alone screening campaigns tend to employ clinical models of delivery focused on individual behaviour and through a disease specific lens. This paper describes a case study of a 2010 stand-alone campaign in Tanzania to argue that exclusively clinical approaches can undermine screening efforts by premising that women will act outside their social and cultural domain when responding to screening services. A focus on sociocultural barriers dictated the approach and execution of the intervention. Our experience concurs with that in similar settings elsewhere, underscoring the importance of barriers situated within the sociocultural milieu of societies when considering prevention interventions. Culturally competent delivery could contribute to long-term reductions in late stage presentation and increases in treatment acceptance. We propose a paradigm shift in the approach to stand-alone prevention programmes.
authors.affiliation: a Faculty of Health Sciences , Simon Fraser University , Burnaby , Canada.
authors.forename: Dilshad
authors.initials: D
authors.lastname: Kassam
authors.affiliation: a Faculty of Health Sciences , Simon Fraser University , Burnaby , Canada.
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Berry
authors.affiliation: b Director of Medical Services , Aga Khan Health Services Tanzania , Dar es Salaam , Tanzania.
authors.forename: Jaffer
authors.initials: J
authors.lastname: Dharsee
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control* / Q000523:psychology; D000073116:Cancer Survivors / Q000706:statistics & numerical data; D003150:Community Health Workers / Q000193:education* / Q000458:organization & administration / Q000523:psychology; D054521:Cultural Competency; D055088:Early Detection of Cancer / Q000379:methods / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006293:Health Promotion / Q000379:methods / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008402:Mass Media; D008403:Mass Screening / Q000379:methods / Q000458:organization & administration* / Q000523:psychology; D008571:Men / Q000193:education* / Q000523:psychology; D019982:Organizational Case Studies; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology*; D011204:Poverty Areas; D012944:Social Support; D013636:Tanzania / Q000453:epidemiology
keywords: Breast cancer; culture and cancer control; low and middle-income countries; screening; sociocultural barriers