Uptake of Breast Cancer Screening Practices in Low and Middle-Income Countries: A Systematic Review and Meta-Analysis.

Abstract

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 (LMICs) has not been synthesized. We aimed to systematically quantify uptake of breast cancer screening in LMICs. 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 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. 174 population-based studies encompassing >78 million women were included. Pooled prevalence of self-reported uptake of screening mammography, self-reported having had clinical breast examination for screening, and self-reported regular breast self-examination (relevant for breast awareness in LMICs) were 22.7% (95% CI: 18.6-27.2), 23.1% (95% CI: 19.5-27.0), and 14.6% (95% CI: 11.6-17.9) respectively. 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 slightly decreased. Women who lived in rural area, were single, had lower income level, 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. This meta-analysis identified concerningly low uptake of breast cancer screening practices in LMICs. Governments should prioritize developing context-appropriate strategies to address this low uptake to support population-level stage-shifting of breast cancer in LMICs.