title: Exploring stigma as a barrier to cancer service engagement with breast cancer survivors in Kampala, Uganda.
abstract: To understand the role of stigma in the delay of cancer service engagement by women with breast cancer in Kampala, Uganda.
  
  
  
  Women in Sub-Saharan African countries are twice as likely to die from cancer as women in high-income countries, which is largely attributable to late diagnosis. While breast cancer-related stigma has been identified in Sub-Saharan Africa, limited research focuses on how stigma impacts the behavior of breast cancer patients in Uganda.
  
  
  
  This qualitative study used a grounded theory approach to examine illness narratives from 20 breast cancer survivors in Uganda, gathered through semistructured interviews.
  
  
  
  Thematic analysis showed that perceived and internalized stigma associated with breast cancer influenced care engagement throughout illness, delaying engagement and inhibiting treatment completion. Women identified key factors for overcoming stigma including acceptance of diagnosis, social support, and understanding of breast cancer.
  
  
  
  The growing burden of mortality associated with breast cancer in Uganda can be mitigated by improving early detection and treatment engagement through interventions which account for key psychosocial barriers such as stigma.
authors.affiliation: Department of Global Health, University of Washington, Seattle, WA, USA. elizabeth.meacham@gmail.com.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Meacham
authors.affiliation: Uganda Cancer Institute, Kampala, Uganda.
authors.forename: Jackson
authors.initials: J
authors.lastname: Orem
authors.affiliation: Uganda Women's Cancer Support Organization (UWOCASO), Kampala, Uganda.
authors.forename: Gertrude
authors.initials: G
authors.lastname: Nakigudde
authors.affiliation: National Cancer Institute, Rockville, MD, USA.
authors.forename: Jo Anne
authors.initials: JA
authors.lastname: Zujewski
authors.affiliation: Department of Global Health, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
authors.forename: Deepa
authors.initials: D
authors.lastname: Rao
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology*; D057210:Delayed Diagnosis / Q000523:psychology*; D055088:Early Detection of Cancer; D005260:Female; D066296:Grounded Theory; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D010465:Perception; D036301:Qualitative Research; D057545:Social Stigma; D012944:Social Support; D012959:Socioeconomic Factors; D017741:Survivors / Q000523:psychology*; D014454:Uganda / Q000453:epidemiology; D016217:Ultrasonography, Mammary
keywords: Uganda; cancer; oncology; qualitative; stigma