Prevalence of advanced-stage breast cancer at diagnosis in Arab countries: A systematic review and meta-analysis

Breast cancer is the most commonly diagnosed malignancy among women in Arab countries, where a substantial proportion present with advanced-stage disease. This systematic review and meta-analysis aimed to quantify the prevalence of stage III-IV breast cancer at diagnosis across the region. We systematically searched PubMed, Scopus, Web of Science, and the WHO Virtual Health Library on March 22, 2025, for studies reporting stage at diagnosis among women with breast cancer in Arab countries. Two reviewers independently screened and extracted data, and risk of bias was assessed using the Joanna Briggs Institute checklist. Random-effects meta-analyses were performed to estimate the pooled prevalence of advanced-stage presentation overall and by country. From 678 screened records, 26 studies from 13 countries comprising 14,176 women were included. The pooled prevalence of stage III-IV breast cancer at diagnosis was 46·0 % (95 % CI 43·0-50·0; I²=93·6 %), with marked heterogeneity across settings (range 13·0 % in Bahrain to 67·0 % in Libya and Yemen). Country-level subgroup differences were statistically significant (χ²=3271·72, df=12; p < 0·001), suggesting that national context may substantially influence diagnostic stage. Egger's test showed evidence of small-study effects (intercept=1·23; p = 0·048). These findings highlight the enduring challenge of late breast cancer diagnosis in the Arab region. Urgent investment in early detection strategies through population-based screening, public awareness, and timely access to diagnostic services is critical to reducing mortality and improving outcomes.