Breast cancer in women in Gaza: qualitative study of women's expectations and experiences of diagnosis and management.

Objective: This study aimed to explore women's awareness of breast cancer and its symptoms, their experiences of accessing healthcare, diagnosis and treatment, and their fears about the stigma associated with the disease in Gaza. Methods: Semi-structured face-to-face in-depth interviews were conducted with a purposive sample of 20 women diagnosed with breast cancer in 2017 and 2018. Interviews were conducted between 2018 and 2021, before the current conflict of 2023-25. They were transcribed verbatim, translated from Arabic to English, uploaded into NVivo™ 12 computer software package and analysed using the Framework approach to identify key themes. Results: Most women presented early with their breast symptoms, but around one half identified delayed diagnosis as a major contributor to subsequent delays in treatment. Despite having relatively good experiences with their surgeons, most were frustrated by a lack of communication between them and their oncologists. Nearly all women expressed feelings of embarrassment about being seen and examined by male clinicians. Many women reported a lack of prompt and effective treatment such as Herceptin and Tamoxifen as the main barrier to cancer care, and this was also true for those who received or should have received Goserelin or radiotherapy. Women agreed that obtaining exit permits from the Israeli authorities to receive necessary treatments outside Gaza was problematic. In addition, the relationship of many married women with their husbands was negatively affected by their diagnosis. Conclusion: Women's accounts demonstrate the need during 2017-21 for clear early detection guidelines for breast cancer to shorten the pre-diagnostic journey, improve referral pathways, build up diagnosis and histopathology capacity to reduce diagnostic delays in Gaza. However, the 2023-25 conflict has led to repeated internal displacements, the destruction of hospitals and clinical networks, and border closures has done little to help improve services and outcomes for these women. Much more work needs to be done to restore these fundamental services for women with breast cancer caught in this conflict.