title: Barriers to early presentation and diagnosis of breast cancer among African women living in sub-Saharan Africa.
abstract: BACKGROUND
  Breast cancer (BC) has been described as the leading cause of cancer deaths among women especially in the developing world including sub Saharan Africa (SSA). Delayed presentation and late diagnosis at health facilities are parts of the contributing factors of high BC mortality in Africa. This review aimed to appraise the contributing factors to delayed breast cancer presentation and diagnosis among SSA women.
  
  
  METHODS
  Five databases encompassing medical and social sciences were systematically searched using predefined search terms linked with breast cancer presentation and diagnosis and sub Saharan Africa. Reference lists of relevant papers were also hand searched. Quality of quantitative and qualitative articles were assessed using the National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the Critical Appraisal Skills Programme (CASP) quality appraisal checklist. Thematic analysis was used to synthesize the qualitative studies to integrate findings.
  
  
  RESULTS
  Fourteen (14) quantitative studies, two (2) qualitative studies and one (1) mixed method study merited inclusion for analysis. This review identified low knowledge of breast cancer among SSA women. This review also found lack of awareness of early detection treatment, poor perception of BC, socio-cultural factors such as belief, traditions and fear as factors impacting African women's health seeking behavior in relation to breast cancer.
  
  
  CONCLUSIONS
  Improving African women's knowledge and understanding will improve behaviors related to breast cancer and facilitate early presentation and detection and enhance proper management and treatment of breast cancer.
authors.affiliation: Christian Service University College, Kumasi, Ghana.
authors.forename: Cynthia Pomaa
authors.initials: CP
authors.lastname: Akuoko
authors.affiliation: Christian Service University College, Kumasi, Ghana.
authors.forename: Ernestina
authors.initials: E
authors.lastname: Armah
authors.affiliation: Christian Service University College, Kumasi, Ghana.
authors.forename: Theresa
authors.initials: T
authors.lastname: Sarpong
authors.affiliation: Graduate School of Public health, Seoul National University, Seoul, South Korea.
authors.forename: Dan Yedu
authors.initials: DY
authors.lastname: Quansah
authors.affiliation: Garden City University College, Kumasi, Ghana.
authors.forename: Isaac
authors.initials: I
authors.lastname: Amankwaa
authors.affiliation: Julius Global Health, University Medical Center, Utrecht University, the Netherlands.|School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Daniel
authors.identifier: http://orcid.org/0000-0001-7568-7298
authors.initials: D
authors.lastname: Boateng
mesh_terms: D017954:Africa South of the Sahara; D001943:Breast Neoplasms / Q000175:diagnosis*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D064887:Observational Studies as Topic; D036301:Qualitative Research; D012307:Risk Factors