Early detection of breast cancer in industrially developing countries

Although the incidence of breast cancer is lower in industrially developing countries than in developed ones, half the global toll of breast cancer is in developing countries. As in the West, the incidence of breast cancer is rising in developing countries, and strategies for controlling breast cancer need to be defined taking into account the prevailing socio-economic realities. Mammography is unlikely to be a cost-effective approach to early detection. Because most breast cancers in developing countries occur in women below the age of 50, mammography is also likely to be less effective. The success of breast self-examination (BSE) requires strong motivation and the recognition that breast cancer is a potential hazard. Both these requirements are unlikely to be met in developing countries and, consequently, compliance will be low and BSE will not be performed properly. Nevertheless, the teaching of BSE may be used as a medium for increasing awareness about breast cancer. Physical examination (PE) of the breast conducted by female health workers is likely to be the most appropriate approach to early detection in developing countries. To be cost-effective, PE should be integrated into already existing health care programmes which reach women in their homes. The effectiveness of PE in the early detection of breast cancer has been underestimated, and evidence is reviewed which suggests that it may be a simple and inexpensive alternative to mammography screening even in developing countries.