Knowledge and Screening Practices of Breast and Cervical Cancer in Rural and Urban South Africa

Background: The South African government has recently released cancer policies for breast and cervical cancer—the most common types and causes of cancer-related death in South African women. Increased mortality rates and advanced disease at presentation in comparison with developed countries suggests a need for greater awareness of risk factors, screening and preventative methods individualized for the population at risk. Aim: To characterize and compare the knowledge base and perceptions of women in urban and rural settings, we assessed these factors in two different cohorts in South Africa. Methods: A cross-sectional sample was taken in South Africa of women invited to participate in a survey regarding breast and cervical cancer knowledge, and awareness of risk factors, prevention and screening. Participants were approached in shopping malls and health facilities in urban Johannesburg in 2015 (“urban”) and semirural Bushbuckridge, 450 km northeast of Johannesburg (“rural”) in 2016. Results: 600 total women were surveyed, with 300 from each cohort. 83% of the urban cohort completed matriculation or higher, versus 60% of rural participants for whom high school was their highest level of education. Both groups demonstrated comparable levels of cancer awareness, and > 70% felt that cervical cancer is preventable. While the urban cohort was more knowledgeable about Pap smears (76% vs. 66%, P = 0.004), > 75% of both cohorts were willing to get one. Although both groups were largely unfamiliar with the role of HPV in cervical cancer, rural women were more aware of HIV (38% vs. 59%, P < 0.0001), smoking (43% vs. 62%, P < 0.0001) and parity (39% vs. 54%, P = 0.00019) as risk factors. Nevertheless, urban participants were more knowledgeable about breast self exams (71% vs. 59%, P = 0.001) and mammograms (62% vs. 42%, P < 0.0001), and more likely to undergo one (79% vs. 66%, P = 0.0002). Both groups identified family history and genetics as risk factors, but rural women appeared more aware of the roles of diet (30.67% vs. 39.93%, P = .011), oral contraceptives (17.33% vs. 34.77%, P < .0001), alcohol (26.67% vs. 52.15%, P < .0001) and lack of exercise (8.67% vs. 55.12%, P < .0001). Conclusion: Overall knowledge of breast and cervical cancer did not differ between both groups, despite varying levels of education and geographic setting. Women in the rural cohort demonstrated more awareness of several oncologic risk factors. Yet, the greater familiarity with and uptake of screening methods, especially for breast cancer, among women in the urban cohort may point to the benefits of proximity to health care infrastructure, such as tertiary care centers. This data supports a need for further implementation and distribution of cancer care services within cancer policies, to capitalize on increasingly sufficient levels of awareness among South African women.