The Influence of Sociodemographic Factors on Women’s Breast Cancer Screening in Accra, Ghana


  • Margaret Amenuke-Edusei CENTRAL UNIVERSITY, TEMA
  • Charles M. S. Birore Norfolk State University



breast cancer, breast self-examination, Africa, mammogram screening, sociodemographic factors, breast neoplasm, mammography


Ghana has a relatively low incidence rate of women’s breast cancer compared to more developed countries. However, the breast cancer’s mortality rate is higher in the former compared to the latter. In Ghana, the role of social work in health care is limited or is not recognized. The purpose of this study was to explore the influence of sociodemographic characteristics, access to healthcare providers, and physicians’ recommendations on Ghanaian women’s breast cancer screening practices. A cross-sectional survey and convenience sample were used to collect data from 194 Ghanaian women after approval was obtained from two Institutional Review Boards, authors of instruments used, and the participants. Univariate, chi-square, and logistic regression statistics were used to analyze data. Seventy-one percent of the participants reported practicing breast self-examination (BSE) and 14% reported mammogram screening. While educational level and employment were positively associated with BSE, a regular visit to healthcare providers was negatively associated with BSE. Income and physicians’ recommendations were positively associated with mammogram screening. Ghanaian women’s low level of mammogram screening calls for first, increasing breast cancer awareness and education to counteract negative personal and cultural beliefs relating to breast cancer and screening. Second, social workers in collaboration with health professionals and social justice agencies should advocate and lobby for health insurance legislation which mandates coverage of mammogram screening services. Finally, introducing oncology social work to the curriculum of social work educational programs in Ghana is needed to prepare social workers to address psychosocial challenges relating to breast cancer.


Abdulai, T., Abobi-Kanbigs, D. A., Joseph, S. K., Adiboka, A. G., & Solomon, C. (2017). Bridging the inequitable distribution of physicians in Ghana: Factors medical students and house officers at UDS and TTH will consider in accepting postings to northern Ghana. Journal of Healthcare Communications, 2(2), 1-6.

Ahmadian, M., Samah, A. A., Redzuan, M., & Emby, Z. (2012). Predictors of mammography screening among Iranian women attending outpatient clinics in Tehran, Iran. Asian Pacific Journal of Cancer Prevention, 13(3), 969-974.

Akhigbe, A. O., & Omuemu, V. O. (2009). Knowledge, attitudes and practice of breast cancer screening among female health workers in Nigerian urban city. BioMed Central Cancer, 9(1), 203-312.

Akuoko, C. P., Armah, E., Sarpong, T., Quansah, D. Y., Amankwaa, I., & Boateng, D. (2017). Barriers to early presentation and diagnosis of breast cancer among African women living in sub-Saharan Africa. PLoS One, 12(2), 1-18.


Alkhasawneh, I. M. (2007). Knowledge and practice of breast cancer screening among Jordanian nurses. Oncology Nursing Forum, 34(6), 1211-1217.


American Cancer Society [ACS]. (2017). Breast cancer: Facts and figures 2017-2018.

ACS. (2018). The American Cancer Society’s principles of oncology: Prevention to survivorship. John Wiley & Sons.

ACS. (2019). American Cancer Society recommendations for the early detection of breast cancer.

ACS. (2020). American Cancer Society breast cancer screening guidelines.

Amu, H., Dickson, K. S., Kumi-Kyereme, A., & Dateh, A. K. M. (2018). Understanding variations in health insurance coverage in Ghana, Kenya, Nigeria, and Tanzania: Evidence from demographic and health surveys. PLoS One, 13(8), 1-14.

Atobrah, D. (2012). When darkness falls at mid-day: Young patients’ perceptions and meanings of chronic illness and their implications for medical care. Ghana Medical Journal, 46(2S), 46-53.

Boxwala, F. I., Bridgemohan, A., Griffith, D. M., & Soliman, A. S. (2010). Factors associated with breast cancer screening in Asian Indian women in Metro-Detroit. Journal of Immigrant and Minority Health, 12(4), 534-543.


Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R. L., Torre, L. A., & Jemal, A. (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: Cancer Journal for Clinicians, 68(6), 394-424.

Chan, D. N. S., & So, W. K. W. (2015). A systematic review of randomly controlled trials examining the effectiveness of breast and cervical cancer screening interventions for ethnic minority women. European Journal of Oncology Nursing, 19(5), 536-553.

Chiriac, V. F., Baban, A., & Dumitrascu, D. L. (2018). Psychological stress and breast cancer incidence: A systematic review. Clujul Medical, 91(1), 18-26.

Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Routledge Academic.

Creswell, J. W., & Creswell, J. D. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.). Sage.

da Costa Vieira, R. A., Biller, G., Uemura, G., Ruiz, C. A., & Curado, M. P. (2017). Breast cancer screening in developing countries. Clinics (Sao Paulo, Brazil), 72(4), 244–253.

Dey, S. (2014). Preventing breast cancer in LMICs via screening and/or early detection: The real or the surreal. World Journal of Clinical Oncology, 5(3), 509-519.

Edgar, L., Glackin, M., Hughes, C., & Rogers, K. M. (2013). Factors influencing participation in breast cancer screening. British Journal of Nursing, 22(17), 1021-1026.

Esteva, M., Ripoll, J., Leiva, A., Sánchez-Contador, C., & Collado, F. (2008). Determinants of non-attendance to mammogram program in a region with high voluntary health insurance coverage. BioMed Central Public Health, 8(1), 387-396.

Fogg, B. J. (2009). A behavior model for persuasive design.


Francies, F. Z., Hull, R., Khanyile, R., & Dlamini, D. (2020). Breast cancer in low-middle income countries: Abnormality in splicing and lack of targeted treatment options. American Journal of Cancer Research, 10(5), 1568-1591.

Ghana Statistical Service. (2012). The 2010 population and housing census: Summary report of final results.

Gøtzsche, P. C., & Jørgensen, K. J. (2013). Screening for breast cancer with mammography. Cochrane Database of Systematic Reviews, 2013(6), 1-73.

Gregory-Mercado, K. Y., Will, J. C., True, S., Royalty, J., Starcher II, E. T., Khavjou, O., Helsel, W., Kammerer, W., & Howe, W. (2007). A combined approach to women’s health is associated with a greater likelihood of repeat mammography in a population of financially disadvantaged women. Preventing Chronic Disease: Public Health Research, Practice and Policy, 4(4), 1-9.

Guvenc, I., Guvenc, G., Tastan, S., & Akyuz, A. (2012). Identifying women’s knowledge about risk factors of breast cancer and reasons for having mammography. Asian Pacific Journal of Cancer Prevention, 13(8), 1491-1497.


Hinyard, L. J., Wirth, L. S., Clancy J. M., & Schwartz, T. (2017). The effect of marital status on breast cancer-related outcomes in women under 65: A SEER database analysis. The Breast, 32, 13-17.

Ibrahim, N. A., & Odusanya, O. O. (2009). Knowledge of risk factors, beliefs and practices of female healthcare professionals towards breast cancer in a tertiary institution in Lagos, Nigeria. BioMed Central Cancer, 9(76), 1-8.

International Agency for Research on Cancer [IARC]. (2016). Handbooks of cancer prevention: Breast cancer screening (vol. 15), Lyon, France: IARC Press.

IARC. (2018). Breast cancer factsheet.

Jensen, L. F., Pedersen, A. F., Andersen, B., & Vedsted, P. (2012). Identifying specific non- attending groups in breast cancer screening: Population-based registry study of participation and socio-demography. BioMed Central Cancer, 12(159), 1-9.

Johnson, O. E. (2019). Awareness and practice of breast self-examination among women in different African countries: A 10-year review of literature. Nigerian Medical Journal, 60(5), 219-225.

Jørgensen, K. J., & Gøtzsche, P. C. (2009). Overdiagnosis of publicly organised mammography screening programmes: Systematic review of incidence trends. British Medical Journal, 339(1), 1-8.

Jørgensen, K. J., Gøtzsche, P. C., Kalager, M., & Zahl, P-H. (2017). Breast cancer screening in Denmark: A cohort study of tumour size and overdiagnosis. Annals of Internal Medicine, 166(5), 313-323.

Kiguli-Malwadde, E., Mubuuke, A. G., Businge, F., Kawooya, G. M., Nakatudde, R., Byanyima, K. R., & Muyinda, Z. (2010). Current knowledge, attitudes and practices of women on breast cancer and mammogram at Mulago Hospital. Pan African Medical Journal, 5(1), 9-21.

Langkemp, D. L., Lehman, A., & Lemeshow, S. (2010). Techniques for handling missing data in secondary analyses of large surveys. Academic Pediatrics, 10(3), 205-210.

Laryea, D. O., Awuah, B., Amoako, Y. A., Osei-Bonsu, E., Dogbe, J., Larcen-Reindorf, R., Ansong, D., Yeboah-Awudzi, K., Oppong, J. K., Konney, T. O., Boadu, K. O., Nguah, S. B., Titiloye, N. A., Frimpong, N. O., Awittor, F. K., & Martin, I. K. (2014). Cancer incidence in Ghana, 2012: Evidence from a population- based cancer registry. BioMed Central Cancer, 14, 362-370.

Litaker, D., & Tomolo, A. (2007). Association of contextual factors and breast cancer screening: Finding new targets to promote early detection. Journal of Women’s Health, 16(1), 36-45.

Marmot, M. G., Altman, D. G., Cameron, D. A., Dewar, J. A., Thompson, S. G., & Wilcox, M. (2013). The benefits and harms of breast cancer screening: An independent review. British Journal of Cancer, 108(11), 2205-2240.

Matthew, A. (2018). Global survey of clinical oncology workforce. Journal of Global Oncology, 4, 1-12.

Myers, E. R., Moorman, P., Gierisch, J. M., Havrilesky, L. J., Grimm, L. J., Ghate, S., Davidson, B., Mongtomery, R. C., Crowley, M. J., McCrory, D. C., Kendrick, A., & Sanders, G. D. (2015). Benefits and harms of breast cancer screening: A systematic review. Journal of American Medical Association, 314(15), 1615-1634.

National Cancer Institute [NCI]. (2017). Mammograms.

Nelson, H. D., Pappas, M., Cantor, A., Griffin, J., Daeges, M., & Humphrey, L. (2016). Harms of breast cancer screening: Systematic review to update the 2009 U.S. Preventive Services Task Force Recommendation. Annals of Internal Medicine, 164(4), 257-267.

Opoku, S. Y., Benwell, M., & Yarney, J. (2012). Knowledge, attitudes, beliefs, behavior and breast cancer screening practices in Ghana, West Africa. Pan African Medical Journal, 11, 28-37.

Park, M. J., Park, E-C., Choi, K. S., Jun, J. K., & Lee, H-Y. (2011). Socio-demographic gradients in breast and cervical cancer screening in Korea: The Korean National Cancer Screening Survey (KNCSS) 2005-2009. BioMed Central Cancer, 11(257), 1-8.

Parsa, P., Kandiah, M., Zulkefli, N., & Rahman, H. (2008). Knowledge and behavior regarding breast cancer screening among female teachers in Selangor, Malaysia. Asian Pacific Journal of Cancer Prevention, 9, 221-227.

Raosoft Incorporated. (2004). Sample size calculator. Seattle, WA.


Renshaw, C., Jack, R. H., Dixon, S., Moller, H., & Davies, E. A. (2010). Estimating attendance for breast cancer screening in ethnic groups in London. BioMed Central Public Health, 10(1), 1-8.

Schueler, K. M., Chu, P. W., & Smith-Bindman, R. (2008). Factors associated with mammogram utilization: A systematic quantitative review of the literature. Journal of Women’s Health, 17(9), 1477-1498.

Secginli, S., & Nahcivan, N. O. (2005). Factors associated with breast cancer screening behaviors in a sample of Turkish women: A questionnaire survey. International Journal of Nursing Studies, 43(2), 161-171.

Shirazi, M. A. (2006). Breast cancer screening behaviors among immigrant Iranian women in the United States (Doctoral dissertation). Oregon, Oregon State University.

Statista. (2020). Density of medical doctors in West Africa in 2020 by country (per 10,000 inhabitants).

Sutradhar, R., Gu, S., & Paszar, L. F. (2016). Multi-state transitional models for measuring adherence to breast cancer screening: A population-based longitudinal cohort study with over two million women. Journal of Medical Screening, 24(2), 75-82.

Tabachnick, B. G., & Fidell, L. S. (2012). Using multivariate statistics (6th ed.). Pearson.

Tavafian, S. S., Hasani, L., Aghamolaei, T., Zare, S., & Gregory, D. (2009). Prediction of breast self-examination in a sample of Iranian women: An application of the Health Belief Model. BioMed Central Women’s Health, 9, 37-44.

United Kingdom Independent Panel on Breast Cancer Screening. (2012). The benefits of and harms of breast cancer screening: An independent review. Lancet, 380(9855), 1778-1786.

United States Preventive Services Task Force. (2016). Final recommendation statement: breast cancer screening. Author.

World Health Organization [WHO]. (2018). Cancer: Key facts.

WHO. (2019). Cancer: Early diagnosis.

WHO. (2020). Breast cancer.