Authors
1
Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran;
2
Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran;
3
Radiation Oncology Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran;
4
Department of Nursing, College of Nursing, Michigan State University, East Lansing MI, USA;
5
Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
10.30476/ijcbnm.2025.104511.2632
Abstract
Background: Delayed breast cancer diagnosis in low- and middle-income countries (LMICs) reduces
the survival rates. This review identifies the causes of these delays to inform strategies for improving
early detection.
Methods: This scoping review followed the Arksey and O’Malley framework to explore the factors
contributing to delayed breast cancer diagnosis in LMICs. Seven databases, including PubMed, Scopus,
Web of Science, Cochrane Library, ProQuest, Embase, and Magiran, were searched for English and
Persian studies published between January 2000 and September 2024. The search combined the
keywords (e.g., “diagnostic delay,” “missed diagnosis,” “breast cancer,” “late-stage,” “barriers”), using
Boolean operators. To focus on LMICs, we applied country filters, where available, and supplemented
the search with manual screening of reference lists from the included studies.
Results: The initial database search identified 5,313 records. After removing 1,036 duplicates, 4,277 studies
were screened based on title, abstract, and country of origin. Of these, 4,217 were excluded for reasons
including irrelevance to delayed breast cancer diagnosis, study design, population, setting (e.g., highincome
countries), or publication date (outside 2000–2024). The remaining 60 studies met the inclusion
criteria and were included in the narrative synthesis. Extracted data were organized and interpreted using
the revised Penchansky framework (accessibility, availability, acceptability, affordability, accommodation,
awareness). Additional themes included misdiagnosis, competing priorities, and personal factors.
Conclusions: Multiple modifiable factors contribute to diagnostic delays in LMICs. Addressing them
can accelerate diagnosis, improve outcomes, and reduce harm. Targeted improvements in these areas
offer significant potential to enhance breast cancer care and save lives in LMICs.
Keywords
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