Priority Research Topics for Breast Cancer in Low- and Middle-Income Countries (LMICs)
Research on early detection strategies and implementation should be prioritized for breast cancer in LMICs to improve survival outcomes and reduce mortality through stage shifting at diagnosis.
Understanding the Current Landscape
Breast cancer is the most common cancer among women globally and the leading cause of cancer mortality in women, with over 1.1 million new cases diagnosed annually and more than 410,000 deaths worldwide 1.
In LMICs, breast cancer is becoming an increasingly urgent problem with incidence rates rising by up to 5% per year, yet most breast cancer deaths occur in developing countries 1.
Most women in LMICs present with locally advanced or metastatic breast cancer, leading to poor prognosis and requiring more resource-intensive treatment 1.
Priority Research Areas
1. Early Detection and Screening Implementation
Research on culturally appropriate and resource-stratified early detection programs is urgently needed, as current uptake of breast cancer screening practices in LMICs is alarmingly low at only 22.7% for mammography and 23.1% for clinical breast examinations 2.
Studies should focus on breast awareness programs and clinical breast examination as cost-effective alternatives to mammography in basic resource settings 3.
Implementation research is needed to address barriers to early detection, including sociocultural factors, stigma, and lack of awareness that contribute to late-stage presentation 4.
2. Pathology and Diagnostic Capacity Building
Research on developing low-cost, point-of-care diagnostic tests for molecular evaluations (estrogen receptor, HER2 status) is critical, as these are essential for treatment decisions but often unavailable in LMICs 5.
Studies on quality assurance methods for pathology services in resource-constrained settings are needed to improve diagnostic accuracy 5.
3. Treatment Optimization for Limited Resources
- Research on adapting treatment protocols to resource-constrained settings is essential, including studies on:
4. Health Systems and Policy Research
Studies on developing cancer registries and data collection systems are crucial for understanding disease burden and guiding resource allocation 1.
Implementation research on translating evidence-based guidelines into policy and practice in LMICs is needed 3.
Research on cost-effectiveness of various breast cancer control strategies specific to LMIC contexts would help prioritize interventions 1.
5. Technology Adaptation and Innovation
Research on "leapfrog technologies" that bypass traditional infrastructure requirements could improve breast cancer care in LMICs 5.
Studies on the effectiveness of mobile health (mHealth) technologies for awareness creation and increasing screening compliance are needed 4.
Implementation Considerations
Research should address country-specific contexts, as "programs must be built that are specific to each country's unique situation" 1.
Studies should consider both urban and rural settings, as women in rural areas are less likely to access screening services 2.
Research on education and training curricula specific to LMICs is needed to build sustainable capacity 3.
Common Pitfalls to Address in Research
Avoid simply transplanting high-resource country guidelines to LMICs without adaptation, as these may be inappropriate due to infrastructure limitations, cultural barriers, and resource constraints 1.
Research must account for competing health priorities in LMICs and demonstrate cost-effectiveness of breast cancer interventions 1.
Studies should address the full continuum of care rather than focusing on isolated components, as fragmented approaches may not improve outcomes 3.
By prioritizing these research areas, we can develop evidence-based strategies to improve breast cancer outcomes in LMICs through earlier detection, accurate diagnosis, and appropriate treatment within resource constraints.