Breast cancer early detection methods for low and middle income countries, a review of the evidence.

Organized national mammographic screening has been adopted as the gold standard for breast cancer early detection in western countries; however it may not be the most cost-effective approach to early detection in low and middle income countries (LMC) as it is very demanding in terms of human and financial resources. Moreover, its benefit to harm ratio has been questioned lately, particularly in women <50 years, the age group which produces the majority of breast cancer cases in LMC. In the past few years, evidence about alternatives to mammographic screening that would benefit LMC populations have been produced. They are reviewed and discussed in the present paper, together with evidence about mammographic screening relevant to LMC. Alternative screening tests (clinical breast-exam and self breast-exam) are examined, then the pro- and cons- for various strategies (opportunistic screening, population based screening and clinical downstaging) are discussed.