With the increase in incidence and mortality of breast cancer in low-income countries (LICs), the question of whether LICs should promote breast cancer screening for early detection has gained tremendous importance. Because LICs have limited financial resources, the value of screening must be carefully considered before integrating screening programs into national healthcare system. Mammography—the most commonly used screening tool in developed countries—reduces breast cancer-specific mortality among women of age group 50–69, but the evidence is not so clear for younger women. Further, it does not reduce the overall mortality. Because the women in LICs tend to get breast cancer at younger age and are faced with various competing causes of mortality, LICs need to seriously evaluate whether mammographic screening presents a good value for the investment. Instead, we suggest a special module of clinical breast examination that could provide similar benefits at a very low cost. Nevertheless, we believe that LICs would obtain a much greater value for their investment if they promote primary prevention by tobacco cessation, healthier food and healthier lifestyle campaigns instead.
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This paper was presented in part at the 10th European Breast Cancer Conference (EBCC), Amsterdam, The Netherlands. Dr. Gyawali received Fellowship Grant for Developing Countries from the EBCC to participate and present in the conference.
BG conceptualized the study and wrote the first draft. All authors provided intellectual feedback, made revisions and approved the final manuscript.
Conflict of interest
Unrelated to the paper, Yuichi Ando has received grants from Sanofi, Torii Pharmaceutical, Nippon Kayaku, Mitsubishi Tanabe Pharma and Mochida Pharmaceutical; grants and personal fees from Chugai Pharmaceutical, Takeda Pharmaceutical, Daiichi Sankyo, Kyowa Hakko Kirin, Eisai, Taiho Pharmaceutical, Yakult Honsya and Merck Serono; and personal fees from Ono Pharmaceutical, Eli Lilly Japan, Pfizer, Novartis Pharma, Janssen Pharmaceutical, Hisamitsu Pharmaceutical, Mochida Pharmaceutical, AstraZenaca, GlaxoSmithKline, ASKA Pharmaceutical, Terumo and Bayel Holdings. All other authors declare no competing interests.
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Gyawali, B., Shimokata, T., Honda, K. et al. Should low-income countries invest in breast cancer screening?. Cancer Causes Control 27, 1341–1345 (2016). https://doi.org/10.1007/s10552-016-0812-8
- Breast cancer
- Clinical breast examination