Bridging the Breast Cancer Detection Gap Across Lower-and Middle-Income Countries

In many low- and middle-income countries, the "diagnostic window" for breast cancer is characterized by a median tumor size of 3.5 cm and a late-stage presentation rate of up to 60%. While high-income countries rely on mammography for early detection, the lack of infrastructure and high costs in low-resource settings necessitate a more accessible, evidence-based approach to clinical triage.

The BCRADS-2 Implementation Study addresses this gap by validating a structured Breast Clinical Reporting and Data System (BCRADS). This system provides a standardized formula that integrates patient history—including age, family history, and genetic risk—with key clinical examination findings such as breast asymmetry and lump mobility. By assigning objective scores to these parameters, the system creates a clear triage pathway: scores above a threshold of 7 indicate a high likelihood of malignancy, triggering expedited biopsies and fast-track referrals.

In this interview, Soumen Das, MBBS, MS, FACS, founder and director of the Institute of Breast Diseases, Kolkata, and head of the Department of Surgical Oncology at Netaji Subhas Chandra Bose Cancer Hospital, explores how the BC-RADS scoring flow achieved a 93.2% sensitivity and 88.7% specificity in a prospective trial. He discusses the rationale for moving toward a standardized clinical model that empowers frontline health care workers—from doctors to rural health workers—to reduce diagnostic delays and align with the WHO Global Breast Cancer Initiative goals.

Transcript:

Once a patient comes to the outpatient department or consults a primary care physician, we have a fixed formula of taking a few questions from the history and a few questions from the clinical examination, some findings of the clinical examination. In the [patient] history, we consider the age, we consider the family history, we consider the genetic [predisposition]. We consider the history of radiation exposure, any prior history of irradiation in the chest wall, especially for Hodgkin lymphoma in the childhood. [With] these few points in the history and in the clinical examination, we have categorized whether the patient has breast asymmetry, whether the skin and nipple changes are present, whether the lump is present, what are the clinical features, and whether the [patient] has any lump in the axilla or not. Based on these, we have used this formulation retrospectively in our data [collected], and we could come out with these [guidelines]. Based on these parameters, the clinician has to just note down whether they are present or absent, but based on that, we score the breast lump. We score the patient. If the score is more than 7, there is a high likelihood of [malignancy] being present in the breast lump. If the patient is having a score of more than 7, then it [sets off] an alarm for the clinician. Now here we have an objective evaluation of the breast lump or the symptoms, and based on the score, we can suggest the next scope of action. If the score is benign or probably benign, then we follow up with these patients. If the score is high, we go for a biopsy. If the score is very high, then we go for a fast-track referral system where biopsy is expedited. That’s how the scoring system works.

Reference

Das S, Paul R, Mandal TK, et al. Community-integrated early breast cancer detection in LMICs using BC-RADS: the breast clinical reporting and data system (BCRADS-2 Implementation Study). Accessed January 27, 2026.