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

Abstract Background Cancer represents a significant public health challenge in Sudan, with rising incidence and mortality rates. Despite its impact, cancer awareness remains suboptimal, and barriers to early detection and timely healthcare-seeking persist, contributing to delayed diagnoses and poor outcomes. Aim This study aimed to assess cancer awareness, knowledge of risk factors and symptoms, and identify barriers to cancer care among adults in Khartoum State, Sudan. Methods A population-based, descriptive cross-sectional study was conducted from January to February 2022 in Khartoum State. A total of 418 Sudanese adults aged 18 years and older, without prior cancer diagnoses, were selected through multistage cluster random sampling. Data were collected via face-to-face interviews using a modified and validated Arabic version of the Cancer Awareness Measure (CAM). Descriptive statistics, Mann-Whitney U, Kruskal-Wallis tests, Chi-square, and multiple linear regression were performed. Statistical significance was set at p < 0.05. Results The median knowledge score of cancer symptoms was 12 (IQR: 6). While 86.1% recognised a breast lump as a warning sign, only 40.1% identified persistent cough. Significant barriers to healthcare-seeking [E1] included fear of social stigma (81.5%) and preference for traditional medicine (74.9%). Women reported higher rates of stigma and preference for traditional remedies (p < 0.05). Knowledge of symptoms was significantly associated with region of origin and occupation, with medical professionals and individuals from Western Sudan scoring higher (p < 0.05). The regression model identified preference for traditional medicine as the strongest predictor of lower cancer awareness (p < 0.001). Conclusion This study highlights gaps in cancer awareness and the pervasive influence of social stigma and traditional medicine on healthcare-seeking behaviours in Sudan. Culturally tailored education programs, strengthened screening initiatives, and collaboration with community and religious leaders are critical to improving cancer awareness and early detection.