Background: Breast cancer disproportionately impacts low-middle income countries such as Kenya. In Kisumu over 75% of cases present with advanced disease due to high diagnostic costs, limited access, low awareness, and systemic delays. The WHO Global Breast Cancer Initiative targets diagnosis within 60 days(1); Kenya’s National Cancer Control Strategy (2023–2028) emphasizes equitable diagnostic access(2). We have implemented an accelerated histopathological diagnostic project to reduce delays and improve access to diagnosis at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) through subsidized breast core needle biopsy (CNB), histopathology, and immunohistochemistry (IHC) with patient navigation.

Implementation: Collaboration between JOOTRH, Africa Cancer Foundation, and Tiba Foundation (Jan– December 2025) identified 158 patients presenting with breast masses for subsidized CNB, histology, IHC, and navigation. Diagnostic turn-around-times (TAT) and patient-level data were tracked.

Results: 104 patients with invasive breast carcinoma were included; contact-to-biopsy TAT averaged 0.22 days (100% met <2-day target). Average laboratory TAT for histopathology and IHC were 21.4 days (8.65% met 10-day target) and 11.3 days (32.69% met 10-day target), respectively. Mean patient age was 50.11 (±15.4) years, with 48.08% being premenopausal, with a mean of 36.7 (±7.5) years. Most were rural (84.2%), unemployed/informally employed (82.40%), faced median 8-month pre-diagnostic delays, visited multiple hospitals before diagnosis (mean 3.79 hospitals/hospital visits), and reported financial barriers (75%).  48.8% of patients were hormone receptor positive, 14.4% were Her2 amplified, and 28.85% were triple negative breast cancer (TNBC). The median duration of symptoms was 11.5 months (IQR 20.0), and 92.31% presented after more than 3 months of symptomatology. Self-reported barriers to diagnosis were household delays (78.85%) and hospital diagnostic delays (88.46%). 17 (16.35%) women have died; the median duration of follow-up before mortality was 86.1 days.

Conclusion: Access to breast cancer diagnosis remains a challenge in Western Kenya. Importantly, receptor status was unknown compared to Western populations. The project has established baseline data on breast cancer in the region: patients are younger, present with more advanced and aggressive disease, and experience higher mortality rates compared to high-income countries. Critical to designing a comprehensive cancer approach was understanding that rates of Her2/TNBC comprised almost 50% of patients. This data has allowed for targeted planning to shorten histopathology TAT, strengthen referral pathways, and secure sustainable financing for diagnostic services and infrastructure to reduce the mortality burden and to meet the WHO and National Cancer Control program targets.