Breast cancer is the commonest cancer in the majority of low and middle income countries (LMIC's). Survival from breast cancer depends on two main factors – early detection and treatment. In LMICs, delayed presentation of breast cancer is a common occurrence. Barriers to early presentation are lack of access to optimal treatment, lack of financial resources, ignorance and psychosocial issues which include fatalism, fear of death, fear of mastectomy, and lack of autonomy on the part of the woman. Downsizing symptomatic disease as well as screening for asymptomatic disease can reduce mortality from breast cancer. Public education and awareness is a key first step as any early detection program is unlikely to succeed unless the public is aware of the potential benefits. The effectiveness and efficiency of screening modalities including screening mammography, clinical breast examination (CBE) and breast self-examination (BSE) are reviewed in the context of resource availability and population-based need. While mammographic screening is the gold standard for early detection of breast cancer, considerations regarding cost-effectiveness and quality assurance of such a program in LMICs is a concern. The identification of a target group for mammography screening in LMICs should be based on the burden of disease in the population, the potential to benefit from screening, and available resources. Although there may be exceptions, in the absence of such information, the preponderance of the evidence suggests that in most countries it would be reasonable to begin a breast cancer screening program by offering mammography every 2 years to women between the ages of 50 and 65. Although two observational studies on BSE provide evidence that this screening modality reduces breast cancer mortality, this has not been confirmed in two randomized trials. Currently, the evidence is not sufficiently conclusive to justify the recommendation for routine CBE in population-based screening programs, because CBE has not been shown to independently decrease breast cancer mortality, although there are current trials to evaluate this modality. It is also important that any screening program be accompanied by the development of resources required for diagnosis and treatment. The success of any early detection program can be measured by cancer stage at diagnosis, and eventually improvement in survival.
Citation Information: Cancer Prev Res 2011;4(10 Suppl):ED06-02.