Breast cancer in Bosnia and Herzegovina: real-world patterns of diagnosis, treatment, and survival outcomes.

Timely diagnosis is critical for improving breast cancer outcomes, especially in resource-limited health systems. This study provides the first real-world evidence from Bosnia and Herzegovina on diagnostic and treatment intervals, adherence, and survival in women with breast cancer. We conducted a retrospective analysis of breast cancer cases diagnosed between 2019 and 2023 at the Clinical Centre University of Sarajevo, the largest cancer center in the country, managing approximately 60% of cases in the Federation of Bosnia and Herzegovina. Most patients (78.1%; 95% CI: 73.8-82.3) were diagnosed through self-referral due to symptoms, with 62.4% of cancers detected at stages 1 and 2. The mean patient and system diagnostic intervals were 38.1 days (95% CI: 23.4-52.8) and 38.6 days (95% CI: 29.9-47.3), respectively, with a total diagnostic interval of 70 days (95% CI: 58.9-82.5). Almost all diagnostic procedures had a waiting time of less than ten days. Among all women undergoing surgery, radical mastectomy was performed in 61% (95% CI: 55-66), while among women with stage 1-2 disease, 55% (95% CI: 48-62) underwent radical mastectomy. Treatment duration averaged 3.7 months for chemotherapy (95% CI: 3.4-4.1) and 0.48 months for radiotherapy (95% CI: 0.26-0.69), with higher compliance for radiotherapy (99.5%; 95% CI: 98-100) than chemotherapy (78%; 95% CI: 72-84). Three-year progression-free survival was 85.7%, and overall three-year survival was 86%. Early breast cancer detection and favorable survival can be achieved even in resource-constrained settings.