Prospects for Population-Based Breast Cancer Screening in Nigeria: An Integrative Literature Review

PURPOSE: Breast cancer is the most common cancer and the second leading cause of death among women in Nigeria, with a 5-year survival of 44% versus 90% in the United States. Screening has been promoted to reduce breast cancer mortality. However, there is a paucity of data on the readiness of the Nigerian health system to deliver cancer screening at scale effectively. METHODS: An integrative literature review on the readiness of the Nigerian health care system to support ongoing organized breast screening activities was conducted. The Web of Science, African Journal Online, OVID Medline, Cumulative Index to Nursing and Allied Health Literature, Embase, and PsycINFO databases were searched for relevant terms. Using the Wilson-Jungner framework (1968), a narrative synthesis of relevant studies was performed to highlight areas for future research, practice, and service planning investment. RESULTS: Forty-four papers were included. Access to diagnostic facilities remains limited, and distribution appears predominantly urban. Significant cultural, religious, and socioeconomic barriers limit the utilization of the available imaging services. Cost remains a significant barrier as the financial burden of out-of-pocket expenses for diagnosis and treatment is overwhelming for many households. Prioritizing cost-effective investments in infrastructure and training, and implementing standardized, evidence-based diagnostic pathways for symptomatic women, may address existing challenges and enhance early diagnosis. CONCLUSION: Through the lens of the Wilson-Jungner framework, there are significant barriers to effective breast cancer screening in Nigeria. There should be a focus on expanding the early diagnosis of symptomatic patients and strengthening the cancer registries.