Breast cancer screening or early detection in low- and middle-income countries: choosing the wise first step

Abstract

Breast cancer control in low- and middle-income countries (LMICs) is frequently framed as a choice between screening and early detection. This framing is misleading: screening is not an alternative to early detection but one component of it. Drawing on the World Health Organization’s Global Breast Cancer Initiative, this editorial distinguishes early diagnosis of symptomatic women from population screening of asymptomatic women, and argues that in resource-limited systems early diagnosis should be built first. The dominant clinical problem in LMICs is late presentation rather than missed subclinical disease; lower incidence, high infrastructure demands, and a contested benefit-to-harm balance further weaken the case for early mammographic screening. Detection, moreover, is of value only where a functioning diagnostic and treatment pathway exists. A pragmatic, sequenced strategy is proposed—strengthening early diagnosis and referral first, adding clinical-breast-examination-based screening thereafter, and reserving organised mammographic screening for systems able to sustain it—underpinned by investment in a national cancer registry.