Closing the breast cancer gap in low- and middle-income countries

Breast cancer is the most commonly diagnosed cancer among women worldwide and one of the leading causes of cancer deaths in low- and middle-income countries (LMICs). Yet while treatment advances have improved survival rates globally, women in LMICs continue to face late diagnoses, unaffordable treatment, and limited access to essential medicines.

The UICC-led Access to Oncology Medicines (ATOM) Coalition has recently produced a series of case studies on health financing in the Philippines, Kenya, Zambia, and Georgia. They highlight how persistent barriers to affordable breast cancer care in low- and middle-income countries drive survival inequities and point to an urgent need for systemic solutions.

Breast cancer is one of the most frequently diagnosed cancers across all four countries, according to the findings. In the Philippines and Kenya, breast cancer accounts for the largest share of cancer cases (17.5% and 16.2% respectively), while in Zambia, it ranks as the fourth most common cancer. In Georgia, breast cancer consistently ranked higher than colorectal, and lung cancers.

Most women in LMICs are still diagnosed at advanced stages of the disease, when it is harder to treat effectively. In Zambia, the majority of breast cancer cases present at stage III or IV, while in Kenya, 47% of cancer cases are diagnosed at advanced stages, with only 4% of cases diagnosed at stage I.

This is reflected in significantly lower survival rates than in high-income countries. In the US, for instance, the five-year survival rate for women with breast cancer is 91.7%. The estimated survival rate in Georgia is 75.5%, in the Philippines , and 44% in sub-Saharan Africa, including Kenya and Zambia.

Financing remains a critical barrier. In the Philippines, according to the case studies, out-of-pocket spending accounts for nearly half of all health expenditure. This is despite national insurance packages that cover breast cancer treatment.

In Kenya, even with government insurance, patients were left paying almost half of the cost of their cancer care themselves. In Zambia, the case study showed that government allocation for oncology medicines stands at USD 5.5 million annually against a documented need of USD 10 million.

How the ATOM Coalition is supporting change

Sarbani Chakraborty, Technical Advisor for Health Financing at the ATOM Coalition and lead researcher on the case studies, said the figures represent women who are being diagnosed too late, with much higher costs of care, families who are selling their assets to pay for treatment, and medicines that are on national lists but still don’t reach patients in time.

“The ATOM Coalition’s work is focused on helping governments close these gaps by strengthening insurance coverage, improving procurement so medicines actually reach patients, and embedding diagnostics into benefit packages,” she said. “That’s how we can move from late diagnosis to earlier detection, when treatment is not only more effective but costs less, and sustainable access to care.”

For people living with cancer, this means reducing the financial burden of treatment. The ATOM Coalition collaborates with governments to identify where insurance and benefit schemes fall short and aims to identify solutions to strengthen financial protection, ensuring that women are not forced to delay or abandon care due to cost.

For health systems, it means securing access to essential medicines. The Coalition helps countries align their procurement lists with the World Health Organization (WHO)’s essential medicines list, negotiate affordable pricing with pharmaceutical companies, and build more resilient supply chains.

Finally, the ATOM Coalition is helping to ensure that access to diagnostics and medicines is sustainable by supporting countries in mapping the true cost of breast cancer care and the costs of late diagnosis and treatment, and planning budgets that will hold over time. This reduces reliance on short-term donations or external aid, and ensures that once access is achieved, it is not lost in the next budget cycle.

Treatment can’t start without the proper diagnosis. Yet, if mammography, biomarker testing, and other diagnostic tools are not included in public benefit packages, women have to pay out-of-pocket. The ATOM Coalitions model emphasises diagnostics as a core component of breast cancer care, enabling the right medicines to be given to the right person at the right time.

"These findings highlight the stark gaps in breast cancer care for women in LMICs. Systemic solutions require bringing together governments, civil society, and private partners, to jointly overcome these barriers in affordability, access to essential medicines and diagnoses. Through this collective action the ATOM Coalition is helping to build fairer, stronger health systems where a woman’s chance of survival is not dictated by where she lives.”
– Natasha Shah, Executive Director, the ATOM Coalition