A model to enhance breast cancer screening among rural women aged 40-75 years in Sub-Saharan Africa (SSA): A scoping review

Introduction and Background: It is claimed that very little research has been done in Africa on breast cancer screening to identify the best method that can be adopted to have early detection of the malignancy. Breast cancer is a growing burden globally and in Sub-Saharan Africa (SSA). There is a rise in breast cancer mortality in SSA. This is caused by limited breast cancer screening or early detection practices due to limited resources which makes mammography unaffordable by the majority of women. This problem is more prevalent in elderly women living in rural areas where limited or no breast cancer screening is taking place. Downstaging which is context -specific is recommended for African countries but more studies are required to confirm its effectiveness. Objectives: This review aims to identify the gaps in the literature focusing on strategies to enhance breast cancer screening among elderly women aged 40-75 years who reside in rural areas. Inclusion criteria: The articles to be reviewed should focus on screening for the elderly women population that reside in rural areas and should fall within the age range of 40-75 years. Other phrases that can be included instead of breast cancer screening could be early detection measures, early diagnosis, or downstaging. Methodology: The methodology was guided by the published manual for Joana Briggs Institute for scoping reviews. A search of the relevant studies was conducted on 4 October 2022 across PubMed, SCOPUS, Embase, and EBSCO Host databases. The systematic literature search strategy was developed and carried out using the Medical Subject Heading (MeSH) database. The eligibility criteria were developed using the Participants, Concept, and Context framework. Only articles written in English and published between 2010 and 2022 were considered. Removal of duplications was done first, followed by screening using the article title and abstract and then using full -text articles. The results of the search were profiled on the PRISMAScR flow chart diagram. Themes were identified from the conclusions of the reviewed studies. Results: After searching 78 citations were identified. These were screened and only 8 were left after the different stages of screening. The reviewed articles were published between 2010 and 2020. The majority (75%) of the studies were surveys except for two which were qualitative and all done in Kenya. No mixed methodology study was done. No study focused on developing a model to enhance breast cancer screening among rural women aged 40-75 years although there are very few countries in Africa with established nationwide breast cancer screening guidelines. Conclusion: There are limited studies done on breast cancer screening of elderly rural women in SSA. No study was done to identify a model to enhance breast cancer screening among the rural elderly women population. None of the reviewed studies utilized the mixed methodology design to have an in-depth context -specific understanding to pave the way for the implementation of downstaging which is recommended for countries with limited resources. Contribution: The scoping review indicated the gap in research in terms of breast cancer screening among women aged 40-75 years who reside in rural areas and highlighted the future need for such studies to make downstaging effective.