Breast cancer screening in developing countries

The incidence of breast cancer in developing countries is rapidly on the rise, and cancers are generally detected at advanced stages when a cure is not possible. If advanced cancers could be down-staged by earlier detection, many lives can be saved. However, can a screening program be successfully implemented in these countries? A high level of compliance at every level of a screening program is essential for its success. In the absence of a high level of awareness, compounded by a fatalistic attitude to life, the necessary level compliance may not be achieved. Furthermore, in view of a relatively low incidence, many women will have to be screened to detect a breast cancer; and hence a screening program may not be cost effective. It is not clear which is the best screening test to be employed; although clinical breast examination would seem appropriate, there is currently no randomized evidence that it would lead to mortality reduction. The most reasonable approach to breast cancer control in developing countries would be to provide the minimal level of cancer care that will reduce mortality and suffering, as well as to enlighten the population about the benefits of early detection using innovative approaches. (C) 2011 Elsevier Inc. All rights reserved.