Cancer Screening in Afghanistan: A Narrative Review of Feasibility, Barriers, and Evidence-Based Strategies for Low-Resource Settings

Afghanistan experiences a substantial cancer burden within the South Asian Association for Regional Cooperation region, with poor outcomes largely linked to delayed diagnosis and limited access to diagnostic and treatment services. The national cancer profile is dominated by malignancies commonly observed in low-resource settings, including cancers of the breast, gastrointestinal tract, and cervix. This narrative review examines the limitations of commonly used cancer screening modalities, the systemic and sociocultural barriers to their implementation in Afghanistan, and feasible strategies for early cancer detection in resource-constrained environments. Conventional screening approaches, such as endoscopic procedures, imaging-based screening, and cytology-based tests, face significant challenges related to infrastructure, workforce capacity, affordability, and accessibility, limiting their widespread use. Screening for less prevalent cancers is discussed in the context of uncertain feasibility and limited applicability in low-resource health systems. Afghanistan's healthcare system continues to face structural constraints, including fragmented oncology services, limited diagnostic capacity, and the absence of coordinated screening frameworks. These challenges are further compounded by sociocultural factors such as low health awareness, stigma, gender-related barriers, and financial hardship, all of which reduce screening uptake and delay care-seeking. In addition, weaknesses in health information systems hinder effective cancer surveillance and planning. This narrative (non-systematic) review emphasizes pragmatic, low-cost approaches to cancer screening and early diagnosis that can be integrated into existing primary healthcare services, highlighting frontline healthcare worker training and community engagement as realistic pathways to improving early detection under severe resource limitations.