Challenges to the early diagnosis and treatment of breast cancer in developing countries

Abstract

This critical review of the literature assembles and compares available data on breast cancer clinical stage, time intervals to care, and access barriers in different countries. It provides evidence that while more than 70% of breast cancer patients in most high-income countries are diagnosed in stages I and II, only 20%-50% patients in the majority of low- and middle-income countries are diagnosed in these earlier stages. Most studies in the developed world show an association between an advanced clinical stage of breast cancer and delays greater than three months between symptom discovery and treatment start. The evidence assembled in this review shows that the median of this interval is 30-48 d in high-income countries but 3-8 mo in low- and middle-income countries. The longest delays occur between the first medical consultation and the beginning of treatment, known as the provider interval. The little available evidence suggests that access barriers and quality deficiencies in cancer care are determinants of provider delay in low- and middle-income countries. Research on specific access barriers and deficiencies in quality of care for the early diagnosis and treatment of breast cancer is practically non-existent in these countries, where it is the most needed for the design of cost-effective public policies that strengthen health systems to tackle this expensive and deadly disease.

Keywords: Breast cancer, Early diagnosis, Delays, Time intervals, Clinical stage, Access, Health care delivery

Core tip: This review assembles the available data on breast cancer clinical stage for 10 high-income and 13 low-income countries and the time intervals from symptom discovery to cancer diagnosis and treatment for 33 countries. Most breast cancer patients in low-income countries suffer very long delays and are diagnosed in advanced stages. The scant available evidence for low and middle-income countries suggests that access barriers and quality deficiencies in cancer care are determinants of these delays.