**7. Strategies to prevent the growing burden of NCDs in sub-Saharan Africa**

Establishing primary prevention programs for breast cancer remains a challenge. Nevertheless, efforts to decrease excess body weight and alcohol consumption and to encourage physical activity and breastfeeding may have an impact on stemming the incidence of breast cancer worldwide. Population-wide breast cancer screening programs aim to reduce breast cancer mortality through early detection and effective treatment [2]. Reports have indicated that women who participated in breast cancer screening programs have a lower risk of dying from breast cancer compared with the corresponding risk from nonparticipants [2, 35].

There should be early diagnosis and prompt treatment to prevent and control breast cancer globally, specifically in sub-Saharan Africa. The WHO recommends organized, population-based mammography screening every 2 years for women at average risk for breast cancer aged 50 to 69 years in well-resourced settings [13]. The American cancer society (ACS) recommends that generally, women should have the opportunity to begin yearly screening for women between 40 and 44 years. This should continue as long as they are in good health and have a life expectancy of at least 10 years. ACS strongly recommends that women with an average risk of breast cancer should begin mammography screening beginning at age 45. Those between 45 and 54 years should be screened annually and those at least 55 years should be screened biennially or whenever an opportunity comes up [36]. Clinical breast examination is not directly effective in reducing breast cancer mortality among average-risk women at any age according to guidelines and recent systematic reviews [14, 36].

Mammographic screening, however, has limitations, such as overdiagnosis and overtreatment [2, 37, 38]. There are opportunities to improve the cost-effectiveness and benefit-to-harm ratio of screening by adopting a risk-stratified screening strategy using existing and evolving risk prediction models [2, 37]. Therefore offering breast cancer only to women with higher risk can improve the cost-effectiveness of screening, maintains the benefits and reduce overdiagnosis [37]. Ongoing screening trials are evaluating the clinical acceptability, cost and utility of risk-stratified screening programs in the general population [2, 39, 40].

The establishment and funding of cancer registries is a veritable tool in the prevention and control of breast cancer in sub-Saharan Africa as it can generate *Epidemiology of Breast Cancer in Sub-Saharan Africa DOI: http://dx.doi.org/10.5772/intechopen.109361*

recent, accurate data on the incidence, survival, treatment and outcomes in nations/ populations hosting such registries [41, 42]; as revealed in some reports reviewed in this update [8, 12, 25]. Though there are cancer registries in only 54% of the 46 countries in sub-Saharan Africa; improved budgeting and infrastructure will improve the availability of data on cancer diagnosis, treatment, follow-up and survival [41, 43]; which can help in the estimation of cancer burden in sub-Saharan Africa and improve the policy and practice of the national cancer control programs which can improve the healthcare for patients with breast cancer in the years to come [41]. However, due to resource constraints in many countries of sub-Saharan Africa, hospital-based cancer registries can be established which can be a source of information on breast cancer (and other cancers) for the population-based cancer registries [43].

Finally, there is a need to ameliorate the financial burden of cancer prevention and care in sub-Saharan Africa; especially among the high-risk population and the vulnerable [42]. This is because the majority of healthcare financing in sub-Saharan Africa is out-of-pocket which places catastrophic healthcare expenditure on patients and caregivers [44, 45]. There is therefore the need increase include cancer screening and care in universal healthcare programs and policies of governments in sub-Saharan Africa [42].

#### **8. Conclusion**

Breast cancer has increasingly become a disease of global public health importance, and in particular in sub-Saharan Africa. It has been projected to increase to over 3 million by the year 2040. This might have been due to improved detection rates, awareness, and treatments globally; especially in higher-income countries. There appears to be an intra- and inter-country variation in breast cancer detection rates and mortality in sub-Saharan Africa. BRACA genes still appear to be commonly reported; though, some populations have commonly reported novel genes more than the former genes. Better organized screening programs, the establishment of a well-functioning cancer registry, and improved access and utilization of mammography and treatment services in resource-constrained regions can improve early presentation, reduce adverse breast cancer-related outcomes (including mortality) and help reduce future sub-Saharan African burden of breast Africa and the world.

*Breast Cancer Updates*
