Mastectomy for Breast Cancer in Nigeria: A Mixed‐Methods Study of Barriers, Facilitators, and Patient Attitudes

Abstract

BACKGROUND: Approximately half of Nigerian women with non-metastatic breast cancer undergo surgery, yet psychosocial factors influencing mastectomy receipt are poorly understood. AIMS: This study aimed to understand barriers, facilitators, and patient attitudes toward mastectomy for breast cancer in Nigeria. METHODS: Using a prospective, convergent mixed-methods study design, we disseminated a structured questionnaire (N = 225) and conducted in-depth interviews (N = 18) among women with non-metastatic breast cancer recommended for mastectomy at 3 academic Nigerian institutions. Logistic regression identified factors associated with mastectomy within 1 year of diagnosis; interviews were analyzed using the framework method. Qualitative and quantitative themes were triangulated using a joint display. RESULTS: Median age was 48 years (IQR 40,57); median tumor size was 6.6 cm (IQR 4.4,10.1). One hundred patients (44%) underwent mastectomy, 97 within 1 year of diagnosis. Nineteen percent (n = 42/224) had not heard of breast cancer before diagnosis; 37% (n = 82/223) had not heard of mastectomy. Interview participants expressed negative emotions toward mastectomy. Of those who did not receive surgery, the most common reasons were cost (n = 41/125, 33%), loss to follow-up (n = 20/125, 16%), traditional medicine (n = 13/125, 10%), death (n = 12/125, 9.6%), and disease progression (n = 9/125, 7.2%). In multivariable analysis, awareness of mastectomy (OR 4.10, 95% CI 1.64,10.7, p-value = 0.003) was significantly associated with surgery receipt within 1 year. CONCLUSIONS: This study identified patient factors related to mastectomy receipt, including education and awareness, financial burden, fear of surgery, anticipated body image changes, and concern about adverse social impacts. Public health education about breast cancer surgery, pre-mastectomy counseling/peer-support, and financial may facilitate mastectomy receipt.