Gatekeepers or barriers? Exploring traditional medicine practitioners' understanding of breast cancer in Ghana

In Ghana, traditional medicine practitioners (TMPs) are often the first point of contact for women with breast health concerns. However, they operate independently of formal healthcare services. While their embeddedness within communities grants them cultural legitimacy, their perceptions of breast cancer remain underexplored. Understanding TMPs' explanatory models, recognition of signs, and diagnostic practices is crucial for improving early detection of breast cancer and reducing delays in accessing treatment that lead to poor outcomes.

We conducted a qualitative exploratory descriptive study using semi-structured interviews with 14 non-formally trained TMPs involved in breast care services in Ghana. Interviews were transcribed, translated, and thematically analyzed to understand how they recognize and interpret symptoms, their beliefs about the causes and risks of breast cancer, and how they diagnose and treat breast-related problems.

Our analysis generated four major themes: sources of knowledge, multi-dimensional explanations of breast cancer causation, cardinal signs defining breast cancer recognition, and experiential and practice-based approaches to diagnosis. TMPs relied on inherited ancestral traditions but also sought to improve their skills through workshops, professional associations, and occasional biomedical collaborations, showing a willingness to learn and adapt to new information. However, significant misconceptions remained, including beliefs that spiritual or social disharmony and reproductive and lifestyle factors cause breast cancer. While TMPs identified key signs such as lumps, nipple changes, and skin alterations, their dependence on experiential and intuitive diagnostic practices risked both over- and under-diagnosis.

TMPs are central actors in Ghana's breast cancer pathway, representing both opportunities for early recognition and risks of misinformation. Correcting misconceptions and embedding TMPs into structured training and referral systems could reduce diagnostic delays, enhance early detection, and support Ghana's National Cancer Control Plan and Sustainable Development Goal 3.