The World Health Organization (WHO) Regional Office for Africa has launched a new manual to help primary health care workers identify suspected breast cancer earlier, assess symptoms and ensure timely referrals for diagnosis and treatment.
The publication, Evaluation and Workup for Suspected Breast Cancer Using a Primary Health Care Approach, is designed to support nurses, midwives, medical doctors and clinical officers in recognizing warning signs, conducting initial clinical assessments and helping patients navigate diagnostic and treatment services.
The guidance supports implementation of the WHO Global Breast Cancer Initiative (GBCI), which seeks to reduce breast cancer mortality through early diagnosis, timely treatment and quality care.
Breast cancer is the most commonly diagnosed cancer among women worldwide and remains a major cause of cancer-related illness and death in the WHO African Region. In 2022, an estimated 2.3 million women were diagnosed with breast cancer globally, while around 670,000 people died from the disease.
In most countries across the African Region, more than 70% of breast cancer cases are detected at a late stage, limiting treatment options and reducing survival outcomes.
“Primary health care providers are often the first point of contact for women with breast symptoms,” said Dr Benido Impouma, Director of the Health Promotion, Disease Prevention and Control Cluster at WHO Regional Office for Africa.
He explained that strengthening frontline health workers’ ability to recognize warning signs, conduct clinical assessments, provide counselling and facilitate referrals is essential to reducing diagnostic delays.
The manual places particular emphasis on the early diagnosis of women with symptoms, especially in resource-constrained settings where health systems may not yet be equipped to implement organized, population-based mammography screening programmes.
It provides step-by-step guidance on clinical breast assessments, identifying suspicious findings, promoting breast self-awareness, counselling patients and navigating referrals for imaging, pathology and treatment.
According to the guidance, delays of six months or longer between the emergence of symptoms and access to appropriate care remain common in many African settings. Such delays can contribute to advanced-stage disease and preventable deaths.
The manual also highlights the role of primary health care facilities in promoting breast health, initiating referrals and ensuring that patients are not lost to follow-up.
WHO said the publication supports the three pillars of the GBCI: health promotion for early detection, timely diagnosis and comprehensive breast cancer management.
Strengthening primary health care systems can help countries improve patient navigation, expand access to diagnostic services and provide continued support to women throughout treatment and survivorship.
The guidance also emphasizes patient navigation, a personalized approach designed to help women overcome barriers including fear, stigma, geographical distance, financial constraints and fragmented health services.
Primary health care workers are encouraged to facilitate referrals, coordinate care, follow up on missed appointments and connect patients with psychosocial and practical support.
WHO called on member states, health managers, training institutions and development partners to adapt and implement the guidance, strengthen the skills of primary health care workers, establish clear referral pathways and improve links between primary care, diagnostic facilities and treatment services.
“Strengthening breast cancer services at the primary health care level will reduce preventable deaths, advance health equity and accelerate progress towards universal health coverage,” Impouma added.
