Health system barriers to early detection and timely treatment of breast cancer: A scoping review

Abstract

Background

In 2022, breast cancer (BC) had a global mortality rate of 12.7 per 100,000 and 13.2 per 100,000 in Latin America. In Colombia, BC ranked among the leading cancers in terms of incidence and mortality. Delayed diagnosis and treatment worsen prognosis and increase both morbidity and mortality. This review aimed to describe the health system barriers to early detection and timely treatment of BC.

Methods

A scoping review was conducted following the methodology of the Joanna Briggs Institute (JBI). The literature search was carried out in three databases (Medline/PubMed, LILACS, and ScienceDirect). Qualitative and quantitative studies published between 2000 and 2024, in either English or Spanish that examined the health system barriers to the early detection and timely treatment of BC were included. Identified barriers were categorized using the World Health Organization’s Health Systems Framework, which includes service delivery, health workforce, health information systems, access to essential medical products and technologies, health system financing, and leadership and governance.

Results

The search yielded 2603 records, of which 18 studies were included in the review. Eight studies focused on barriers to BC treatment, while the remaining addressed barriers to early detection and diagnosis. The most common barrier identified was related to the service delivery, with geographic inaccessibility emerging as the most significant factor. The second most frequently reported barrier concerned health workforce. Financial limitations, out-of-pocket costs, and lack of resources for BC treatment were identified as financial barriers.

Policy Summary

Barriers to early detection and timely treatment of BC are primarily by service delivery constraints related to geographic access and health workforce barriers, particularly the absence of a doctor-patient relationship. Personal barriers, such as fear of diagnosis or associated pain, religious beliefs and practices, social stigma, and misperceptions about screening programs, were also identified.