Health system barriers influencing timely breast cancer diagnosis and treatment among women in low and middle-income Asian countries: evidence from a mixed-methods systematic review

Abstract

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.

Insurance-based disparities in breast cancer treatment pathways in a universal healthcare system: a qualitative study

“…Our findings partially corroborate recent systematic reviews [7,8] on healthcare system factors that pose barriers to breast cancer diagnosis and treatment in LMICs. Their results, like ours, indicate cost as a major healthcare system factor that hampers diagnosis and treatment.…”

“…'Provider attitude' in that review refers specifically to the pervasive prevalence of corruption, bribery, and nepotism within the medical staff. Another systematic review [7] -this one on healthcare system barriers to breast cancer diagnosis and treatment in LMICs in Asia-arrives at conclusions similar to those of Gbenonsi et al 's review [8]. This review on Asia reveals that the most important barriers are low-quality healthcare, shortages of health personnel, medicines and medical technologies, and a lack of insurance, which has implications for out-of-pocket payments.…”

“…Research into healthcare system influences on breast cancer treatment pathways is growing, but it focuses primarily on lower and middle-income countries (LMICs) [7][8][9]. A systematic review of studies on sub-Saharan African countries [8] identified several healthcare system factors such as diagnostic process failures, cost, and provider attitudes, all of which can erect barriers to access that result in a delay in the diagnosis and treatment of breast cancer patients.…”

Assessing air pollution as a risk factor for early menopause in Korea

“…The phenomenon of early menopause presents additional complexities (Afaya et al, 2022). Women experiencing early menopause also face a heightened risk of developing osteoporosis and cardiovascular diseases following the earlier decline in estrogen levels (LeBoff et al, 2022).…”

Barriers to breast and cervical cancer screening uptake among Black, Asian, and Minority Ethnic women in the United Kingdom: evidence from a mixed-methods systematic review

“…Cancer is currently the leading cause of mortality globally, with new cancer cases estimated at 19.3 million and almost 10 million deaths in 2020 [ 1 – 3 ]. These adverse statistics on cancer have serious implications for global public health, life expectancy, and labour force participation [ 2 , 4 – 6 ].…”