Uptake of breast cancer screening practices in low- and middle-income countries: a systematic review and meta-analysis.

Abstract

Background: Breast cancer is the most prevalent cancer worldwide and the leading cause of cancer mortality in women. Uptake of breast cancer screening and early-detection practices in low- and middle-income countries (LMIC) has not been synthesized. We aimed to systematically quantify uptake of breast cancer screening in LMIC.

Methods: We performed a systematic review and meta-analysis of observational population-based studies that reported the uptake of screening or early-detection practices. We searched the PubMed, Scopus, Embase, and Web of Knowledge databases to January 2024. We pooled data using random-effects meta-analysis and explored heterogeneity using subgroup analyses.

Results: We included 174 population-based studies encompassing more than 78 million women. Pooled prevalence of self-reported uptake of screening mammography was 22.7% (95% confidence interval = 18.6% to 27.2%), of self-reports of having had a clinical breast examination for screening was 23.1% (95% confidence interval = 19.5% to 27.0%), and of self-reported regular breast self-examination (relevant for breast awareness in LMIC) was 14.6% (95% confidence interval = 11.6% to 17.9%). Uptake of breast cancer screening practices was lowest in Africa and low- and lower-middle income countries. Uptake of breast cancer screening practices remained stable over time or decreased slightly. Women who lived in rural area, were single, had lower income levels, had low educational attainment, were unemployed, were uninsured, and had no family history of breast cancer were generally least likely to self-report uptake of breast cancer screening.

Conclusion: This meta-analysis identified concerningly low uptake of breast cancer screening practices in LMIC. Governments should prioritize developing context-appropriate strategies to address this low uptake to support population-level stage shifting of breast cancer in LMIC.