Background
Breast cancer is the most common cancer among women worldwide and a leading cause of cancer-related mortality, with low- and middle-income countries (LMICs) experiencing a disproportionate burden. To address this challenge, WHO launched the Global Breast Cancer Initiative (GBCI) in 2022, introducing the 60–60–80 targets focused on early-stage detection, timely diagnosis, and completion of appropriate treatment. While population-based mammography screening has reduced breast cancer mortality in high-income countries, its implementation in LMICs is limited by infrastructure, workforce, and financial constraints. As a result, clinical breast examination (CBE) has been adopted as a more feasible early detection strategy in several LMICs, although standardized evaluations of large-scale CBE-based programs remain scarce.
In Egypt, breast cancer is a major public health concern. In 2019, the President’s Initiative on Women’s Health (PIWH) was launched as part of the national Multisectoral Action Plan for Noncommunicable Diseases, incorporating population-based CBE screening with the goal of reducing breast cancer mortality by 25% by 2030. The program was rapidly scaled nationwide across all governorates.
 Objectives
To describe the organization, policies, and early performance of Egypt’s national CBE-based breast cancer screening program during its first screening round (July 2019–June 2021), using standardized indicators from the Cancer Screening in Five Continents (CanScreen5) project.
Methods
A program evaluation was conducted within the CanScreen5 framework of IARC. Information on program organization, governance, financing, service delivery, human resources, information systems, and quality assurance was collected using a validated structured questionnaire completed by national program coordinators. Aggregate performance data from the first screening round were submitted through a standardized CanScreen5 performance questionnaire. Key performance indicators included screening coverage, CBE positivity rate, compliance with diagnostic assessment, cancer detection rate, proportion of carcinoma in situ, and positive predictive value of CBE. Data were reviewed and validated in collaboration with national experts.
Results
The program operates under a national policy guaranteeing free breast cancer screening, diagnostic work-up, and treatment. Screening is offered biennially to average-risk women aged 40 years and older through CBE performed at primary health centers by trained providers. Women with positive CBE findings are referred for further assessment at designated tertiary Healthcare hospitals, supported by patient navigation and active follow-up.
During the first screening round, 5.99 million of 18.9 million eligible women were screened, achieving a coverage of 31.7%. The CBE positivity rate was 10.0%, and 65.3% of women with positive findings completed further assessment. Breast cancer was diagnosed in 5,335 women, including 283 cases of carcinoma in situ. The cancer detection rate was 0.89 per 1,000 women screened, carcinoma in situ represented 5.3% of detected cancers, and the positive predictive value of CBE was 1.37%.
Conclusion
Egypt’s national CBE-based breast cancer screening program demonstrates substantial organizational capacity and large-scale implementation within a resource-constrained setting. Early performance indicators highlight both the reach and limitations of CBE-based screening. These findings provide important evidence for LMICs pursuing GBCI-aligned breast cancer control strategies and underscore the need for continued strengthening of diagnostic compliance, information systems, and program evaluation.