The WHO Regional Office for Africa has launched new guidance to help primary health care workers identify suspected breast cancer, conduct an initial clinical assessment and ensure timely referral to diagnosis and treatment services. The initiative comes as more than 70% of breast cancer cases are detected at a late stage in most countries across the African Region.
The new manual, titled Evaluation and workup for suspected breast cancer using a primary health care approach, targets nurses, midwives, medical doctors and other clinical staff working at the frontline of health systems. It provides practical, step-by-step guidance on assessing breast symptoms, identifying suspicious findings, counseling women and facilitating referrals for imaging, pathology and treatment.
Bringing early detection closer to communities
For the WHO, primary health care facilities can play a critical role because they are often the first point of contact for women who notice changes in their breasts. Strengthening the ability of frontline health workers to recognize warning signs and initiate appropriate referrals could help reduce delays between the appearance of symptoms and access to specialized care
The guidance places particular emphasis on women who already have symptoms. This approach is especially relevant in resource-constrained settings where health systems may not yet have the capacity to organize population-
wide mammography screening programs.
The distinction is important. WHO defines early diagnosis as recognizing symptoms, seeking medical advice, receiving timely clinical evaluation and diagnosis, and being referred for treatment. Screening, by contrast, involves testing an apparently healthy population, usually through mammography, to identify disease before symptoms appear.
Tackling diagnostic delays
Late diagnosis remains a major challenge across the African Region. WHO reports that in most countries in the region, more than 70% of breast cancer cases are detected at an advanced stage. Delays of six months or more between the first appearance of symptoms and receipt of appropriate care also remain common in many African settings.
Such delays can limit treatment options and contribute to preventable deaths. WHO therefore places primary health care at the beginning of a continuum that links community-level services with imaging, pathology and cancer treatment.
The approach also addresses a less visible problem: women being lost during the referral process. Primary health care workers are encouraged to help patients navigate the health system, facilitate referrals, follow up missed appointments and connect women with psychosocial and practical support.
Fear, stigma, distance, financial constraints and fragmented health services can all interfere with timely access to care, according to WHO. Patient navigation is therefore presented as an important component of reducing delays and maintaining women within the care pathway.
A broader response to the breast cancer burden
The new guidance forms part of the WHO Global Breast Cancer Initiative, launched to reduce premature mortality from breast cancer through stronger health systems. Its three main pillars are health promotion for early detection, timely diagnosis and comprehensive breast cancer management.
Globally, an estimated 2.4 million women were diagnosed with breast cancer in 2024, while about 694,000 people died from the disease. WHO says breast cancer remains the most commonly diagnosed cancer among women worldwide.
In Africa, the challenge is not only the number of cases but also the ability of health systems to identify and manage them early. By shifting part of the
response towards primary health care, WHO wants countries to make the first stages of the cancer pathway more accessible while strengthening links with specialized services.
The organization is calling on Member States, health managers, training institutions and development partners to adapt and implement the guidance, strengthen the skills of primary health care workers and establish clear referral pathways to diagnosis and treatment services.
