Awareness and barriers to cancer services in a low-income country: A cross-sectional study in Sudan

Cancer is a disease that does not discriminate, yet its impact is rarely felt equally across the globe. In many parts of the world, the greatest barrier to survival is not the lack of medicine, but the delay in seeking it. When a person notices a strange lump, a persistent cough, or unexplained weight loss, the decision to visit a doctor is often clouded by fear, cost, or deep-seated cultural beliefs. In low-income nations, where healthcare infrastructure is often stretched thin, these delays can turn a treatable condition into a fatal one. Understanding why people wait is just as critical as developing new drugs. If researchers can identify the specific fears and misconceptions that keep people away from clinics, public health officials can design campaigns that speak directly to those concerns, potentially saving lives before the disease reaches an advanced stage.

In Sudan, a team of researchers set out to map these invisible barriers. They focused on the capital city, Khartoum, conducting a survey of 418 adults who had never been diagnosed with cancer. The goal was simple but vital: to see what people knew about the warning signs of cancer and to understand what stopped them from going to the doctor when they felt something was wrong. The team used a structured questionnaire, asking participants to identify symptoms like unexplained lumps or bleeding, and to rate how much they feared social judgment, the cost of treatment, or the reliability of modern medicine compared to traditional remedies. They also asked about their knowledge of screening programs for breast, cervical, and bowel cancers.

The results painted a picture of a population caught between awareness and hesitation. Most participants could identify the most obvious signs of cancer. Nearly 86 percent correctly recognized that an unexplained lump could be a warning sign, and about 62 percent knew that unexplained weight loss was a danger signal. However, knowledge became patchier with less obvious symptoms. Only 40 percent identified a persistent cough as a potential warning, and fewer than half recognized unexplained bleeding. This gap suggests that while the public understands the dramatic signs of the disease, they often miss the subtler, early indicators that could lead to an earlier diagnosis.

The study also revealed that where a person came from and what they did for a living mattered. People from Western Sudan and those working in healthcare had significantly higher knowledge scores than others. Surprisingly, having a friend or family member with cancer did not automatically make someone more knowledgeable about symptoms. The researchers suspect this might be because the stigma surrounding the disease in Sudan is so strong that families often keep the diagnosis a secret, preventing open discussion and learning.

Perhaps the most significant finding was not about what people knew, but what stopped them from acting. The single biggest barrier to seeking medical help was not the cost of treatment or the distance to a hospital, but the fear of social stigma. More than 81 percent of participants agreed that a cancer diagnosis would bring shame or social isolation. Closely following this was a strong preference for traditional medicine over modern chemical treatments, cited by nearly 75 percent of respondents. Women were more likely than men to report these fears and preferences. The data showed that a reliance on traditional remedies was the strongest predictor of lower cancer awareness, suggesting that cultural beliefs are deeply intertwined with health-seeking behavior.

Confusion also surrounded the availability of screening. Although Sudan does not have a national, organized screening program for breast cancer, nearly 89 percent of participants believed one existed. This misconception likely stems from various awareness campaigns and pilot projects that have taken place, leading people to believe a formal system is in place when it is not. For cervical and bowel cancers, awareness was even lower, with about half of the participants unaware of whether screening programs existed at all.

The researchers concluded that while the Sudanese public has a baseline understanding of cancer, deep-seated fears and cultural preferences are creating a wall between patients and care. The study suggests that simply telling people more about symptoms will not be enough. To improve early detection, health programs must address the fear of shame and work alongside community and religious leaders to integrate traditional beliefs with modern medicine. Until the social cost of a diagnosis feels less heavy than the cost of the disease itself, many will continue to wait until it is too late.