Abstract B086: Understanding breast cancer stigma in Rwanda: Perspectives from community health workers

Abstract

Abstract Background: Breast cancer remains the leading cause of cancer-related deaths among women in Africa. In Rwanda, despite the availability of treatment, breast cancer mortality-to-incidence ratio remains above 50%. Research suggests that stigma significantly contributes to delays in care-seeking and poor treatment adherence, thereby increasing mortality risk. Yet, breast cancer stigma in Rwanda remains understudied. Community health workers (CHWs) in Rwanda, who serve as the vital frontline connection between communities and the healthcare system are uniquely positioned to observe and address health-related beliefs and behaviors at the grassroots level. Their insights offer a valuable lens into how breast cancer stigma manifests and influences patient decision-making. Hence, this study sought to explore CHWs’ perspectives on breast cancer and stigma elements, including its sources, influence on decision-making, and impact on care-seeking behaviors in their communities and to identify community-informed strategies to address stigma. Methods: This qualitative study was conducted in June 2024 in Burera District, Rwanda. Forty CHWs were recruited from five health centers and participated in focus group discussions (FGDs), each lasting 60 to 90 minutes and conducted in Kinyarwanda. A semi-structured interview guide, informed by the Health Stigma and Discrimination (HSD) Framework and relevant literature, was used to explore stigma-related domains. FGDs were audio-recorded, transcribed, and translated into English. Data were analyzed using the Framework Method, employing inductive and iterative coding to identify emerging themes. Results: CHWs reported that breast cancer is widely perceived as a fatal illness, leading to stigmatization and social isolation. Stigma was described as occurring at the family, workplace, and community levels. Within families, patients were often seen as a burden, resulting in mistreatment or abandonment by partners. In the workplace, women with breast cancer were perceived as incapable, untrustworthy, or unproductive. At the community level, patients were excluded from social events, subjected to gossip and body shaming, and labeled with offensive terms such as “walking corpse”. Cultural beliefs, including the expectation that a healthy woman should have two breasts, reinforced stigma and influenced life events such as marriage. Compared to other chronic diseases, breast cancer was seen as more stigmatizing, leading to mental distress, social withdrawal, and treatment abandonment. Participants identified lack of knowledge as a major contributor to stigma and emphasized the need to educate families and communities to encourage support and reduce stigma. Conclusion: Our findings highlight the pervasive and multi-level stigma faced by patients with breast cancer in Rwanda. Interventions that engage families and communities, and which leverage the trusted role of CHWs in health education may reduce stigma and increase the willingness of these patients to undergo treatment. Citation Format: Josiane Kabayundo, Aimable Uwimana, Nadine Mugisha, Denys Ndangurura, Denis Regnier, Alexandra Fehr, Eulade Rugengamanzi, Shinobu Watanabe-Galloway, Temidayo Fadelu. Understanding breast cancer stigma in Rwanda: Perspectives from community health workers [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr B086.