Socio-Economic Factors Associated with Cancer Stigma among Apparently Healthy Women in Semi-urban Nepal.

Cancer is the primary cause of death globally, and despite the significant advancements in treatment and survival rates, it is still stigmatized in many parts of the world. However, there is limited public health research on cancer stigma among general population (non-patient) women in Nepal. Therefore, this study aims to determine the prevalence of cancer stigma and its associated factors in this group. Methods: We conducted a cross-sectional study among 426 healthy women aged 30 – 60 years who were residents of Dhulikhel and Banepa in central Nepal. We measured cancer stigma using the Cancer Stigma Scale (CASS). CASS measures cancer stigma in six subdomains (awkwardness, avoidance, severity, personal responsibility, policy opposition, financial discrimination) on a 6-point Likert scale (strongly disagree to agree strongly) with higher mean stigma scores correlating with higher levels of stigma. We used univariable and multivariable linear regression to identify the socio-demographic factors associated with the CASS score. Results: Overall, the level of cancer stigma was low (mean total stigma score: 2.6 ± 0.6) but still present among participants. Stigma related to personal responsibility had the highest levels (mean stigma score: 3.9 ± 1.3), followed by severity (mean stigma score: 3.2 ± 1.3) and financial discrimination (mean stigma score: 2.9 ± 1.6). There was a significant association of mean CASS score with older age (the mean difference is stigma score: 0.01 points; 95% CI: 0.01-0.02) and lower education (difference  -0.02 points; 95% CI: -0.03, -0.003) after adjusting for age, ethnicity, education, marital status, religion, occupation, and parity. Conclusion: While overall cancer stigma was low in Nepal, some subdomains were increased in the general population of women in Nepal. Because stigma may impact engagement in cancer screening efforts, programs should aim to counteract stigma, particularly among older and less educated women. ### Competing Interest Statement The authors have declared that no competing interests exist ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study received approval from Kathmandu University Institutional Review Committee ethical board approved the study (KUIRC no: 35/2021). Trained researchers obtained verbal informed consent from the participants. Separate datasets were prepared, each assigned a unique identity number for anonymous data analysis. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable Data are available within the manuscript as a supporting Information files