Pathways to Breast Cancer Care and Delays in Diagnosis and Treatment in sub- Saharan Africa: A Systematic Review and Meta-Analysis

Background Breast cancer is a leading cause of cancer morbidity and mortality among women worldwide, with disproportionately poor outcomes in sub-Saharan Africa (SSA), where delayed diagnosis and treatment contribute to advanced-stage presentation and reduced survival. This study systematically reviewed and synthesized evidence on pathways to breast cancer care and delays in diagnosis and treatment across SSA. Methods We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. Five electronic databases (PubMed/MEDLINE, EBSCO, CINAHL, Web of Science, and ScienceDirect) were searched for studies published between 2005 and 2025. Twenty-two eligible studies reported pathways to breast cancer diagnosis, patient and diagnostic delays, treatment initiation delays, stage at diagnosis, or barriers to care in SSA. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Newcastle–Ottawa Scale. Random-effects meta-analyses were performed to estimate pooled patient delay, diagnostic delay, and late-stage presentation. Results Twenty-two studies were included in the systematic review, of which twenty contributed to quantitative synthesis. The pooled mean patient delay from symptom recognition to first healthcare contact was 4.89 months (95% CI: 3.51–6.28), while the pooled diagnostic delay from first healthcare contact to confirmed diagnosis was 3.32 months (95% CI: 2.42–4.21). Approximately 68% (95% CI: 62%–74%) of women presented with late-stage disease (stage III–IV). Care pathways were frequently non-linear, with many women initially consulting traditional healers or informal providers before entering formal health systems. Major barriers included poor breast cancer awareness, cultural beliefs favoring traditional medicine, fear and stigma, financial hardship, geographic inaccessibility, referral bottlenecks, and limited diagnostic infrastructure. Conclusions The World Health Organization Global Breast Cancer Initiative (WHO GBCI) recommends that at least 60% of invasive breast cancers should be diagnosed at Stage I or II, diagnostic evaluation should be completed within 60 days of first presentation, and at least 80% of women should receive appropriate multimodal treatment. Women with breast cancer in SSA experience substantial delays in presentation and diagnosis, with most presenting at advanced stages. Strengthening awareness, decentralizing diagnostic services, improving referral systems, and reducing financial and geographic barriers are critical to improving timely breast cancer care in the region. The protocol is registered in PROSPERO (CRD420251240227).