Inventory and needs assessment in francophone LMICs for education, screening and optimal management of breast cancer. The ELISA study.

INTRODUCTION

Breast cancer management in francophone Low- and Middle-Income Countries (LMICs) faces critical challenges due to limited diagnostic and therapeutic resources. The ELISA Project conducted a comprehensive needs assessment to identify priority interventions for improving care in these regions.

METHODS

A structured web-based questionnaire was completed by 105 oncology practitioners across 13 francophone LMICs, including 76 from North Africa and 29 from Sub-Saharan Africa. The survey quantitatively assessed availability and barriers across the cancer care continuum, from screening to treatment. Responses were analyzed using descriptive statistics.

RESULTS

The study revealed profound systemic gaps in breast cancer services. Organized screening programs were reported by only 25% of respondents as being available in their country. Advanced diagnostic capabilities were severely limited, with 70-80% of respondents reporting inadequate access to MRI and prolonged pathology turnaround times of 4-8 weeks. Radiotherapy services were particularly deficient, described as poor by 73% of participants, with fewer than 15% having capacity for modern techniques like intensity-modulated radiotherapy (IMRT). Novel targeted therapies such as CDK4/6 inhibitors were reported as adequately available by only 15% of respondents. Crucially, 80% of healthcare providers identified enhanced training programs and strengthened multidisciplinary collaboration as fundamental requirements for service improvement.

DISCUSSION: These findings expose critical inequities in breast cancer care capacity across francophone LMICs, characterized by infrastructure limitations and financial barriers. The results underscore the urgent need for context-appropriate solutions including screening program development, strategic equipment investments, and international training initiatives to reduce disparities in cancer outcomes.