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<p>Breast cancer remains a leading cause of cancer-related morbidity and mortality worldwide, with disproportionately poor outcomes in low- and middle-income countries (LMICs) driven largely by delayed diagnosis and limited diagnostic capacity. The triple assessment: clinical examination, imaging, and pathological evaluation, represents the diagnostic approach widely used for breast lesions, with imaging playing a pivotal role in lesion detection, characterization, and biopsy guidance. This narrative review examines the performance, applicability, and limitations of current breast imaging modalities, including mammography, ultrasound, magnetic resonance imaging, digital breast tomosynthesis, and contrast-enhanced mammography, within resource-limited settings. A structured search of PubMed, Scopus, and Google Scholar was conducted for studies published between 2000 and 2026 using keywords related to breast imaging, triple assessment, and LMICs. Studies addressing diagnostic performance, implementation challenges, or imaging within resource-limited environments were included, while irrelevant reports and non-peer-reviewed sources were excluded. Relevant data on imaging modality, diagnostic accuracy, study populations, and implementation barriers were extracted and synthesized narratively. Major implementation barriers in LMICs include financial limitations, workforce shortages, infrastructure deficits, inconsistent quality-assurance systems, and limited access to biopsy, pathology, and referral services. Emerging approaches, including task-shifted ultrasound, telemedicine, mobile imaging services, and artificial intelligence, may support diagnostic capacity in selected settings, although evidence remains heterogeneous and LMIC-specific validation is limited. Strengthening breast imaging within resource-stratified diagnostic pathways may contribute to earlier diagnosis and more equitable breast cancer care when integrated with timely tissue diagnosis, pathology support, referral systems, and treatment access.</p>

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Optimizing breast cancer care: imaging challenges and solutions in the triple assessment scheme in resource-limited settings-a narrative review

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年7月7日

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  • Benardine Phillip Mallilah,
  • Nelton Rodrick Thobias,
  • Korduni Mepukori Naisikye,
  • Christine Leons Mmanda,
  • Godwin Alex Mselle

摘要

Breast cancer remains a leading cause of cancer-related morbidity and mortality worldwide, with disproportionately poor outcomes in low- and middle-income countries (LMICs) driven largely by delayed diagnosis and limited diagnostic capacity. The triple assessment: clinical examination, imaging, and pathological evaluation, represents the diagnostic approach widely used for breast lesions, with imaging playing a pivotal role in lesion detection, characterization, and biopsy guidance. This narrative review examines the performance, applicability, and limitations of current breast imaging modalities, including mammography, ultrasound, magnetic resonance imaging, digital breast tomosynthesis, and contrast-enhanced mammography, within resource-limited settings. A structured search of PubMed, Scopus, and Google Scholar was conducted for studies published between 2000 and 2026 using keywords related to breast imaging, triple assessment, and LMICs. Studies addressing diagnostic performance, implementation challenges, or imaging within resource-limited environments were included, while irrelevant reports and non-peer-reviewed sources were excluded. Relevant data on imaging modality, diagnostic accuracy, study populations, and implementation barriers were extracted and synthesized narratively. Major implementation barriers in LMICs include financial limitations, workforce shortages, infrastructure deficits, inconsistent quality-assurance systems, and limited access to biopsy, pathology, and referral services. Emerging approaches, including task-shifted ultrasound, telemedicine, mobile imaging services, and artificial intelligence, may support diagnostic capacity in selected settings, although evidence remains heterogeneous and LMIC-specific validation is limited. Strengthening breast imaging within resource-stratified diagnostic pathways may contribute to earlier diagnosis and more equitable breast cancer care when integrated with timely tissue diagnosis, pathology support, referral systems, and treatment access.