Barriers to screening mammography in developing countries

Background: Breast cancer is the most common non-skin cancer in women and the primary cause of cancer death in women worldwide. Early detection is paramount for increasing survival, and is possible with screening mammography. There are cultural and resource barriers to mammography in developing countries which hinder the early detection of breast cancer and affect health outcomes. Limited existing data explores physician-perceived barriers that would inform interventions to optimize screening.

Methods: We conducted semi-structured, ethnographic interviews with breast imaging radiologists from Azerbaijan, Bosnia and Herzegovina, Egypt, Eritrea, Greece, Syria, and Turkey attending an international breast cancer conference in Ormylia, Greece. One radiologist was randomly selected from each country for a personal interview focusing on the current state of breast health, cancer screening and perceived barriers to care in his/her country. Each interview lasted 15-45 minutes, and was conducted in English by three American medical students. Comparisons between countries were qualitatively analyzed for content, themes and opinions.

Results: All seven physician-radiologists identified financial distress, health care fragmentation, and country-specific cultural stigmas as leading barriers to screening. All reported that breast cancer is usually diagnosed at advanced stages in their countries.

Conclusions: Our data suggest that significant, identifiable barriers to screening mammography exist in developing countries. Characterizing these issues may improve screening and have prognostic implications for women, including immigrants to developed nations.