Should low-income countries invest in breast cancer screening?
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.
Department of Hemato-Oncology, Nobel Hospital, Sinamangal, Kathmandu, Nepal. bg.bishalgyawali@gmail.com.|Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan. bg.bishalgyawali@gmail.com.
Bishal
0000-0001-7444-8594
B
Gyawali
Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan.
Tomoya
T
Shimokata
Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan.
Kazunori
K
Honda
Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan.
Hiroaki
H
Tsukuura
Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan.
Yuichi
Y
Ando
D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics; D003695:Delivery of Health Care / Q000191:economics*; D003906:Developing Countries; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D006801:Humans; D008327:Mammography / Q000191:economics* / Q000706:statistics & numerical data; D008403:Mass Screening / Q000191:economics*; D011203:Poverty
Breast cancer; Clinical breast examination; Cost-effectiveness; Mammography; Screening