Epidemiology, Risk Factors, Health Literacy and Emerging Diagnostic Approaches of Breast Cancer in Sri Lanka: A Systematic Review

Abstract

A thorough grasp of epidemiology and screening techniques is required due to the increasing incidence of breast cancer in Sri Lanka. This review aims to study breast cancer epidemiology, health literacy and screening methods in Sri Lanka. A systematic search was conducted in Medline, Embase, PUBMED, and AMED databases with studies conducted in Sri Lanka up to 2024. Two independent researchers identified 149 studies, from which data were extracted from 27 eligible studies by the PRISMA guidelines. The quality of the studies was evaluated using the quality assessment tools in the National Institute of Health. The available epidemiological data on breast cancer in Sri Lanka are limited. Contributing factors to the high mortality rate include low health literacy, barriers to care, and delays in diagnosis and treatment. The awareness about breast cancer is low, especially regarding diagnosis and breast self-examination (BSE). The practice of BSE is rare. Health education appears to improve health literacy. Notable breast cancer risk factors are menopause, abortions, passive smoking, age (>45), early menarche (<12 years), late menopause (>55 years), no children, oral contraceptives, alcohol and tobacco use, diabetes, family history, radiation, obesity, and prolonged breastfeeding. The screening and diagnosis tests are mammography, breast self-examination, clinical breast examination, molecular detection, and histology. The limited resources allocated for screening and diagnostic services in Sri Lanka present a significant challenge for early detection and management of diseases. The future paths for the diagnosis are considering genetic variations with advanced molecular methods. Considering the high incidence and limited awareness, the adoption of highly accurate screening and diagnosis techniques, with nationally accessible educational programs about breast cancer awareness is necessary.