review · BMC Health Services Research
Breast cancer is the most prevalent cancer and the leading cause of cancer mortality among women in developing nations, with late diagnosis and treatment frequently reported in low- and middle-income Asian countries. A systematic review evaluating 26 studies published between 2012 and 2022 across ten Asian nations examined the health system obstacles influencing timely diagnosis and care. Evaluated using the World Health Organization Health Systems Framework, the review categorised barriers into service delivery, workforce shortages, healthcare financing, information systems, and access to essential medicines and technology. Deficiencies in service delivery, specifically low quality of healthcare, emerged as the most common barrier, followed by workforce shortages including physician unavailability. Major practical impediments included misdiagnosis, prolonged waiting times at facilities, and poor geographical accessibility. Addressing these challenges requires structural health system strengthening, specifically establishing more healthcare facilities and improving workforce training.
Breast cancer causes significant mortality among women in developing regions, largely because patients are diagnosed too late. Identifying specific systemic bottlenecks, including workforce deficits, misdiagnosis, and service delivery failures, provides essential evidence for public health authorities. Addressing these institutional weaknesses can streamline clinical pathways, accelerate diagnosis and treatment, and ultimately prevent avoidable cancer deaths in low- and middle-income settings.
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BACKGROUND: Globally, breast cancer is the most common cancer type and the leading cause of cancer mortality among women in developing countries. A high prevalence of late breast cancer diagnosis and treatment has been reported predominantly in Low- and Middle-Income Countries (LMICs), including those in Asia. Thus, this study utilized a mixed-methods systematic review to synthesize the health system barriers influencing timely breast cancer diagnosis and treatment among women in Asian countries. METHODS: We systematically searched five electronic databases for studies published in English from 2012 to 2022 on health system barriers that influence timely breast cancer diagnosis and treatment among women in Asian countries. The review was conducted per the methodology for systematic reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, while health system barriers were extracted and classified based on the World Health Organization (WHO)'s Health Systems Framework. The mixed-methods appraisal tool was used to assess the methodological quality of the included studies. RESULTS: Twenty-six studies were included in this review. Fifteen studies were quantitative, nine studies were qualitative, and two studies used a mixed-methods approach. These studies were conducted across ten countries in Asia. This review identified health systems barriers that influence timely breast cancer diagnosis and treatment. The factors were categorized under the following: (1) delivery of health services (2) health workforce (3) financing for health (4) health information system and (5) essential medicines and technology. Delivery of health care (low quality of health care) was the most occurring barrier followed by the health workforce (unavailability of physicians), whilst health information systems were identified as the least barrier. CONCLUSION: This study concluded that health system factors such as geographical accessibility to treatment, misdiagnosis, and long waiting times at health facilities were major barriers to early breast cancer diagnosis and treatment among Asian women in LMICs. Eliminating these barriers will require deliberate health system strengthening, such as improving training for the health workforce and establishing more healthcare facilities.
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DOI: 10.1186/s12913-022-08927-x
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