Brazzaville — Across Africa, primary health care facilities are often the first point of contact for women who notice a breast lump or other breast symptoms. However, delays in diagnosis and treatment mean that many breast cancers are detected at advanced stages, when treatment is more complex, costly and less effective.
The World Health Organization (WHO) Regional Office for Africa has launched a new manual, Evaluation and Workup for Suspected Breast Cancer Using a Primary Health Care Approach, to help primary health care workers recognize suspicious breast symptoms, conduct an appropriate initial assessment, facilitate timely diagnosis and support continuity of care across the patient pathway. The guidance supports implementation of the <a href="https://www.who.int/initiatives/global-breast-cancer-initiative” rel=”nofollow noopener” target=”_blank”>WHO Global Breast Cancer Initiative (GBCI), which aims to reduce breast cancer mortality through improved early diagnosis, timely treatment and quality care.
Breast cancer remains the most diagnosed cancer among women worldwide and a leading cause of cancer-related illness and death in the WHO African Region. In 2022, an estimated of 2.3 million women were diagnosed with breast cancer worldwide and approximately 670 000 people lost their lives to the disease. In most countries in the region, more than 70% of breast cancer cases are detected late, reducing treatment options and survival outcomes.
“Primary health care providers are often the first point of contact for women with breast symptoms. Strengthening their capacity to recognize warning signs, conduct an appropriate clinical assessment, provide counselling and ensure timely referral is key to reducing diagnostic delays and improving outcomes,” said Dr Benido Impouma, Director of the Health Promotion, Disease Prevention and Control Cluster at WHO Regional Office for Africa. “This guidance provides frontline health workers with practical tools to support women throughout the continuum of care.”
The manual emphasizes early diagnosis of symptomatic women as a priority in resource-constrained settings particularly where the health system is not yet ready to support an organized population-based mammography screening programme. It provides step-by-step guidance for nurses, midwives, medical doctors and clinical officers to conduct clinical breast assessments, identify suspicious findings, support breast self-awareness, counsel women and navigate referrals to imaging, pathology and treatment services. The manual states that delays of six months or more between the first appearance of symptoms and receipt of appropriate care remain common in many settings across Africa. Such delays contribute significantly to advanced-stage disease and preventable deaths. The new guidance highlights the critical role of primary health care in promoting breast health, assessing symptoms, initiating referrals and preventing women from being lost to follow-up.
The publication supports the three pillars of the WHO Global Breast Cancer Initiative: health promotion for early detection, timely diagnosis and comprehensive breast cancer management. Through strengthened primary health care systems, countries can improve patient navigation, increase access to diagnostic services and support women throughout treatment and survivorship.
The guidance also underscores the importance of patient navigation, an evidence-based, personalized approach that helps women overcome barriers such as fear, stigma, distance, financial constraints and fragmented services. It encourages primary health care workers to facilitate referrals, coordinate care, follow up missed appointments and connect women with psychosocial and practical support, helping to reduce delays and loss to follow-up.
WHO calls on Member States, health managers, training institutions and development partners to adapt and implement the guidance, strengthen the skills of primary health care workers, establish clear referral pathways and ensure effective links with diagnostic and treatment services.
“Strengthening breast cancer services at the primary health care level will reduce preventable deaths, advance health equity and accelerate progress towards universal health coverage,” Dr Benido Impouma added.
