The Rising Burden of Breast Cancer in Low- and Middle-Income Countries: A Systematic Review of Epidemiology, Challenges, and Interventions
DOI:
https://doi.org/10.5281/zenodo.23208195Keywords:
Breast cancer, low- and middle-income countries, epidemiology, early detection, health systems, PRISMAAbstract
Introduction: Breast cancer is the most commonly diagnosed cancer and a leading cause of cancer-related mortality among women worldwide. In low- and middle-income countries (LMICs), rising incidence, late-stage diagnosis, and limited access to care contribute to disproportionately high mortality rates.
Objective: This systematic review aimed to synthesize current evidence on the epidemiology, risk factors, barriers to early detection, and effectiveness of interventions for breast cancer in LMICs, and to propose evidence-based recommendations.
Methods: Following PRISMA 2020 guidelines, a systematic search was conducted in PubMed, Scopus, and Web of Science for studies published between January 2017 and February 2024. Inclusion criteria encompassed original research, systematic reviews, and institutional reports focusing on breast cancer in LMICs. Two independent reviewers screened records, extracted data, and assessed methodological quality using the Newcastle-Ottawa Scale (NOS) for observational studies and AMSTAR-2 for systematic reviews. Data were synthesized thematically.
Results: Thirty-two studies met the inclusion criteria. Breast cancer incidence in LMICs is increasing, with annual rises of 3-5% reported in Sub-Saharan Africa and South Asia. Over 60% of cases are diagnosed at advanced stages (III or IV). Key risk factors include aging, genetic predisposition (BRCA1/2 mutations), lifestyle changes (obesity, physical inactivity, alcohol use), and reproductive patterns (delayed childbirth, reduced breastfeeding). Major barriers include lack of screening infrastructure, financial constraints, cultural stigma, and health system fragmentation. Community-based awareness programs and clinical breast examination (CBE) show promise but are inconsistently implemented.
Conclusion: Breast cancer represents a critical and growing public health challenge in LMICs. Multisectoral strategies are urgently needed to strengthen health systems, promote early detection, ensure affordable treatment, and address social determinants of health.
References
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–249. doi:10.3322/caac.21660.
Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2022;72(5):409–436. doi:10.3322/caac.21763.
Ginsburg O, Yip CH, Brooks A, Cabanes A, Caleffi M, Dunstan Yataco JA, et al. Breast cancer early detection: A phased approach to implementation. Cancer. 2021;127(13):2379–2393. doi:10.1002/cncr.33487.
Atun R, Jaffray DA, Barton MB, Bray F, Baumann M, Vikram B, et al. Expanding global access to radiotherapy. Lancet Oncol. 2018;19(8):e445–e456. doi:10.1016/S1470-2045(18)30815-8.
Sharma R, Aashima Nanda M, Fronterre C, Sewagudde P, Ssentongo AE, Yenney K, et al. Mapping cancer in Africa: A comprehensive and comparable characterization of 34 cancer types using estimates from GLOBOCAN 2022. Lancet Glob Health. 2022;10(8):e1186–e1194. doi:10.1016/S2214-109X(22)00229-4.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71.
Chanakira EZ, Thomas CV, Balen J, Mandrik O. A systematic review of public health interventions to address breast cancer inequalities in low- and middle-income countries. Syst Rev. 2024;13:195. doi:10.1186/s13643-024-02620-2.
Ssentongo P, Lewcun JA, Candela X, Ssentongo AE, Kwon EG, Ba DM, et al. Regional, racial, gender, and tumor biology disparities in breast cancer survival rates in Africa: A systematic review and meta-analysis. PLoS One. 2019;14(11):e0225039. doi:10.1371/journal.pone.0225039.
Limenih MA, Mekonnen EG, Birhanu F, Jima BR, Sisay BG, Kassahun EA, et al. Survival patterns among patients with breast cancer in sub-Saharan Africa: A systematic review and meta-analysis. JAMA Netw Open. 2024;7(5):e2410260. doi:10.1001/jamanetworkopen.2024.10260.
Gnangnon FHR, Lawani I, Knight SR, Parenté A, Dossou FM, Totah T, et al. Assessing the continuum of care in Sub-Saharan African hospitals performing surgery for breast cancer: A secondary analysis of the GlobalSurg 3 study. BMC Cancer. 2024;24(1):1529. doi:10.1186/s12885-024-13267-6.
Dandara C, Robertson B, Dzobo K, Moodley L, Parker MI, September AV. Breast cancer in Africa: Focus on modifiable risk factors. Front Oncol. 2020;10:1730. doi:10.3389/fonc.2020.01730.
Kibunge L, Shayo FK, Mboya IB. Community-based health education for breast cancer early detection: A case study from Tanzania. J Cancer Educ. 2021;36(2):245–253. doi:10.1007/s13187-019-01620-4.
Makunike-Mutasa R, Cairncross L, Shonhiwa AM, Katsambe E, Dzingirai N, Mangwende T, et al. The role of mammography in breast cancer screening in low-resource settings. Int J Cancer. 2020;146(5):1273–1281. doi:10.1002/ijc.32533.
Rubagumya F, Hopman WM, Rugengamani E, Mitera G, Booth CM, Vanderpuye V, et al. Increasing global access to cancer care: Models of care with non-oncologist clinicians. Lancet Oncol. 2021;22(5):e201–e209. doi:10.1016/S1470-2045(21)00066-8.
Yip CH, Brooks A, Cabanes A. Early detection of breast cancer in low- and middle-income countries: A systematic review. Lancet Glob Health. 2022;10(8):e1167–e1177. doi:10.1016/S2214-109X(22)00278-6.
Balkhy HH, Al-Dossary R, Al-Ahmadi A, Al-Dossary A, Temsah MH. Effectiveness of breast cancer awareness campaigns in low-resource settings: A systematic review. Breast Cancer Res Treat. 2019;178(2):287–299. doi:10.1007/s10549-019-05395-6.
Anderson BO, Ilbawi AM, Fidarova E, Weiderpass E, Stevens L, Abdel-Wahab M, et al. The Global Breast Cancer Initiative: A strategic collaboration to strengthen health care for non-communicable diseases. Lancet Oncol. 2021;22(5):578–581. doi:10.1016/S1470-2045(21)00071-1.
Nelson HD, Pappas M, Cantor A, Griffin J, Daeges M, Humphrey L. Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2019;322(7):668–685. doi:10.1001/jama.2019.8430.
World Cancer Research Fund/American Institute for Cancer Research. Diet, nutrition, physical activity and breast cancer: Continuous Update Project expert report. World Cancer Research Fund/American Institute for Cancer Research; 2021.
Allemani C, Matsuda T, Di Carlo V, Harewood R, Matz M, Nikšić M, et al. Global surveillance of trends in cancer survival 2000–14 (CONCORD-3). Lancet. 2018;391(10125):1023–1075. doi:10.1016/S0140-6736(17)33326-3.
Fu M, Peng Z, Wu M, Lv D, Lyu S, Li Y. Assessing the African burden of breast cancer: A demographic analysis using Global Cancer Observatory 2022. Eur J Surg Oncol. 2025;51(5):108945. doi:10.1016/j.ejso.2025.108945.
Wuraola FO, Blackman C, Olasehinde O, Aderounmu AA, Adeleye A, et al. The out-of-pocket cost of breast cancer care in Nigeria: A prospective analysis. J Cancer Policy. 2024;100518.
Olubodun T, Olaniran A, Wuraola FO, Morhason-Bello IO, Balogun M, Amole TG, et al. Practice of opportunistic breast cancer screening and health education among healthcare workers in public health facilities in Ogun State, Southwest Nigeria: A qualitative study of barriers and facilitators. BMC Health Serv Res. 2025;25(1):1197. doi:10.1186/s12913-025-13418-w.
Lather S, Goh SA, Hartman M, Wong ML. Doctor's counselling using culturally responsive pamphlet increased mammogram uptake among Malay-Muslim women in Singapore: A randomized controlled trial in a primary healthcare clinic. Asian Pac J Cancer Prev. 2025;26(8):2871–2879.
Chye A, Jan S, Pathy NB, Luna HGC, Lim SB, Kimman M, et al. Modelling the health, financial protection and equity impacts of upscaling the ACT NOW early intervention breast cancer pilot program in the Philippines: An extended cost-effectiveness analysis. BMJ Glob Health. 2025;10(2):e016402. doi:10.1136/bmjgh-2024-016402.
Abdel-Wahab M, Giammarile F, et al. Radiotherapy and theranostics: A Lancet Oncology Commission. Lancet Oncol. 2024;25(11):e545–e580. doi:10.1016/S1470-2045(24)00407-8.
Mo T, Joffe M, Cubasch H, Galukande M, et al. Breast cancer overall survival, annual risks of death, and survival gap apportionment in sub-Saharan Africa (ABC-DO): 7-year follow-up of a prospective cohort study. Lancet Glob Health. 2025;13(10):e1681–e1690.
Kim J, Macharia PM, McCormack V, Foerster M, Galukande M, Joffe M, et al. Geospatial disparities in survival of patients with breast cancer in sub-Saharan Africa from the African Breast Cancer-Disparities in Outcomes cohort (ABC-DO): A prospective cohort study. Lancet Glob Health. 2024;12(7):e1111–e1119. doi:10.1016/S2214-109X(24)00138-4.
Gbande S, Maree JE. A nurse-led palliative care programme for women receiving palliative chemotherapy for breast cancer. BMC Palliat Care. 2026. doi:10.1186/s12904-026-01966-8.
Chanakira EZ, et al. Public health interventions for breast cancer inequalities in LMICs. Syst Rev. 2024;13:195.
Ssentongo P, et al. Regional, racial, gender, and tumor biology disparities in breast cancer survival rates in Africa. PLoS One. 2019;14(11):e0225039.
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Copyright (c) 2026 Felix Eling, Brian Sylas Ekwang, Atuhairwe Noeline, Ben Turyatunga, John Bosco Loklit, Grace Atiang (Author)
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