Breast Cancer Education and Empowerment in Ethiopia: Evaluating Community-Based Cancer Prevention Efforts Using the RE-AIM Framework

Cancer prevention challenges in Ethiopia include limited community awareness and low uptake of screening, which are in part driven by a lack of culturally and linguistically relevant cancer education appropriate for the diverse indigenous communities of this never-colonized nation. In 2022, a comprehensive multi-media breast cancer (BC) awareness campaign was implemented, featuring local cancer experts and survivors, with community-based screening events in the towns of Adama and Mojo. The RE-AIM framework was used to evaluate and describe its reach, effectiveness, adoption, implementation, and maintenance. Educational pamphlets, videos, social media posts, and interviews were distributed in person and through local and national media networks, reaching tens of millions of people and resulting in 525 individuals screened, with one diagnosis of early-stage cancer. During the free screening events, an interview-administered survey of BC knowledge, attitudes, and screening practices was conducted to inform future cancer education for this population. Among 287 survey respondents, about half correctly identified swelling (46%) or changing nipples/discharge (48.4%) as signs of BC. Maintenance challenges include the lack of a national screening program. Educational resources and a mobile app, translated into the local language, encourage continued patient empowerment to perform breast self-exams. In the absence of established BC prevention programs, "pop-up" mobile screening events can be effective for mobilizing communities to get screened. The paper highlights challenges and lessons gleaned from this community-based BC awareness campaign and screening event to inform future cancer education initiatives in Ethiopia and similar resource-limited settings.