Why is breast cancer survival lower in low-income countries?

How big is the survival gap?

WHO’s Global Breast Cancer Initiative reports five-year net survival by country income group for 2017–2021:

• Low-income countries: 41.9%.
• Lower-middle-income countries: 60.1%.
• High-income countries: 87.3%.
• Global median: 77.8%.

WHO also compares countries by level of human development. In countries with a very high Human Development Index, 1 in 12 women will be diagnosed with breast cancer in their lifetime and 1 in 71 will die of it. In countries with a low index, fewer women are diagnosed (1 in 27) but more die (1 in 48).

Sources: WHO: Global Breast Cancer Initiative; WHO: breast cancer fact sheet

Why are women diagnosed later?

WHO describes delay at each step. Women may not know the signs of breast cancer, or may fear the stigma attached to breast health. Health workers may not recognise early signs and refer on. Tests such as imaging, tissue sampling and laboratory analysis may be far away or slow. WHO notes that in some settings, and among some vulnerable groups, the delay before treatment starts can be more than a year.

Source: WHO: Global Breast Cancer Initiative, operational approach based on 3 pillars

Is the answer more mammogram screening?

Not on its own. WHO says mammographic screening is impractical in many countries at present. It also says earlier diagnosis is possible without it: when women know the signs and symptoms and can reach a clinical evaluation, diagnosis and referral, more are treated before the cancer is advanced. WHO adds that basic diagnostic services are feasible in all settings when they are well organised and lead to timely referral.

Sources: WHO: breast cancer fact sheet; WHO: Global Breast Cancer Initiative, operational approach based on 3 pillars

What does WHO recommend?

The Global Breast Cancer Initiative, set up in 2021, has three pillars, each with a goal:

• Health promotion for early detection: more than 60% of invasive cancers diagnosed at stage I or II.
• Timely diagnosis: evaluation, imaging, tissue sampling and pathology within 60 days.
• Comprehensive management: more than 80% of patients undergo multimodality treatment without abandoning it.

The shared aim is to reduce breast cancer deaths by 2.5% a year, which WHO estimates would avert 2.5 million deaths by 2040.

Sources: WHO: Global Breast Cancer Initiative, operational approach based on 3 pillars; WHO: breast cancer fact sheet

Has any country closed the gap?

Yes. WHO reports that age-standardised breast cancer mortality in high-income countries fell by 40% between the 1980s and 2020, and that countries which succeeded achieved reductions of 2 to 4% a year.

Source: WHO: breast cancer fact sheet

What does Breast Cancer Charity do about it?

Breast Cancer Charity, a campaign of World Aid Network, funds work along the same three steps in low-income communities: breast awareness sessions, clinical breast examination and ultrasound, biopsy and diagnostic work-up, and help with the cost of treatment. It does not fund laboratory research.

Source: Breast Cancer Charity: about us