Abstract PS4-12-02: Challenges in Breast Cancer Screening and Awareness in Sierra Leone - Initiatives by Thinking Pink Breast Cancer Foundation and Breast Cancer Hub

Abstract Background: Breast cancer is a major public health concern in Sierra Leone, contributing significantly to female cancer mortality. Late-stage presentation, lack of screening infrastructure, pervasive stigma, and absence of a national cancer registry hinder effective intervention [1,2]. Limited healthcare access, insufficient trained professionals, and low public awareness further exacerbate the crisis, necessitating community-based solutions and public health education [3]. Patients typically presented only when symptoms were severe, reflecting widespread unawareness, myths, traditional/religious beliefs and financial/geographic barriers to care [4]. Methods: This study presents data from community outreach and screening initiatives conducted by the Thinking Pink Breast Cancer Foundation (TP), a Sierra Leone-based nonprofit, and its collaboration with Breast Cancer Hub (BCH), a U.S.-based nonprofit established in 2017, that joined forces with TP in 2021. BCH expanded the impact through treatment aid for underprivileged patients since 2021 and launched the “One Community Per Month Campaign” in 2024, promoting monthly free screenings and awareness campaigns in schools, markets, and underserved communities. Data was collected by field teams and analyzed using descriptive statistics. Results: From 2012 to 2024, 20,968 individuals (19,719 females and 1,249 males) were screened. Of these, 5,537 showed abnormal symptoms such as pain, itching, swelling, or nipple discharge, leading to ∼26.41% abnormality. During the 2024 “One Community Per Month Campaign,” 772 individuals (683 females, 89 males) were screened, and 91 abnormal cases were identified for further evaluation. Overall, we executed 1,169 lumpectomies. A total of 164 breast cancer cases were confirmed—all at advanced stages. Among them, 100 patients underwent mastectomy, while 63 advanced cases were untraceable due to family-related challenges. Mortality was extremely high: 100 patients died (92 females, 8 males), with only one known survivor. Alarmingly, knowledge of breast cancer symptoms was negligible. None of the participants reported ever performing a Breast Self-Exam (0%) or undergoing a Clinical Breast Exam (0%). Between 2012 and 2024, none of the 4,419 individuals over 40 years (4,328 from general outreach and 168 from the 2024 One Community-Per Month campaign) had ever received a screening mammogram or breast ultrasound—reflecting a 0% prior screening rate in this high-risk group. Visits to healthcare facilities were typically initiated only after symptoms became severe. Geographic and financial barriers, lack of awareness, and limited access to diagnostic services were significant contributors to delayed care. Discussion: The findings highlight a critical public health gap in breast cancer awareness, screening, and early intervention in Sierra Leone. Late-stage diagnoses and near-total mortality among confirmed cases underscore the urgent need for national breast cancer programs. TP and BCH have pioneered community-centered approaches, providing free screenings, awareness education, and patient aid. Their collaborative model demonstrates the potential for grassroots action to drive systemic change. Continued expansion of such programs, combined with national policy support, is essential to reduce preventable deaths and improve survival outcomes in Sierra Leone. References: 1. WHO. Cancer Country Profiles - Sierra Leone. WHO; 2020. 2. Jalloh MB et al. Breast cancer in Sierra Leone: a retrospective review. BMC Cancer. 2024;24(1):112. 3. Kamara S et al. Barriers to early breast cancer detection in Sierra Leone. Int J Cancer Epidemiol. 2022;11(3):204-212. 4. Conteh F et al. Community perceptions and screening behaviors for breast cancer in Freetown. Afr Health Sci. 2023;23(1):55-63. Citation Format: C. Parkinson Pratt, A. Barrie, R. Brewah, J. Kanu, A. Sandy, E. Foday, L. Das Roy. Challenges in Breast Cancer Screening and Awareness in Sierra Leone - Initiatives by Thinking Pink Breast Cancer Foundation and Breast Cancer Hub [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-12-02.