Challenges in breast cancer management in our region, with particular reference to Sri Lanka, and opportunities for regional collaboration
Authors: Dr Randima Nanayakkara
Institution: National Cancer Institute Apeksha Hospital, Maharagama Sri Lanka
Introduction
Breast cancer is the most common cancer among women in Sri Lanka and across South Asia. In Sri Lanka, official records from the National Cancer Control Programme (NCCP 2022) show a steady rise in cases. Breast cancer makes up 28% of all female cancers (n=5447), with a crude rate of 47.6 and an age-standardised rate of 40.3 per 100,000 women. The daily reality is stark: around 17 women are diagnosed and 3 lose their lives to the disease each day, adding up to more than 6,000 cases and over 1,000 deaths every year. The risk climbs sharply after age 35, although the peak is at 225.6 per 100,000 women between the ages of 70 and 74. Furthermore, among patients with recorded staging, nearly one in three (32.4%) are diagnosed late with locally advanced or metastatic disease (Stage III: 24.6%, Stage IV: 7.8%). Adding to the challenge, 59% of patients have no cancer stage recorded in national registry returns, making it difficult to measure long-term survival across the country.
Methods
Sri Lanka provides clinic visits, hospital stays, surgery, radiotherapy, and basic chemotherapy free of charge in public hospitals. Even with universal healthcare, patients still face major delays along the care pathway. As highlighted in the joint IAEA/WHO/IARC imPACT Review (2025), key bottlenecks include: • Delays in Diagnosis: Severe shortages of laboratory technicians, cyto-technicians, and medical physicists, long waiting times of 6-8 weeks for pathology and immunohistochemistry results, and long queues for mammograms and ultrasounds • Drug Shortages & Supply Issues: Frequent stock-outs of essential cancer medicines, a lack of independent quality checks on imported drugs, and limited public funding for newer targeted therapies and gene testing • Radiotherapy Gaps: A shortage of linear accelerators and high dose rate (HDR) brachytherapy units, which leads to long waiting lists for radiation • High Out-of-Pocket Costs: Modest public health spending (1.4% to 1.8% of GDP) forces families to pay out of pocket (46.8% of total health spending) for private tests and medicines.
Results
Meeting the goals of the WHO Global Breast Cancer Initiative (GBCI)—diagnosing at least 60% of cancers at an early stage, completing tests within 60 days, and delivering timely treatment—requires Sri Lanka and neighbouring countries like Bangladesh to work together. Although Sri Lanka has set up over 24 dedicated breast clinics and expanded regional cancer centres, similar challenges exist across the entire region. My keynote speech will include four practical ways. South Asian countries can collaborate: 1. Shared Cancer Registries: Standardising cancer staging and survival tracking across hospital registries to help monitor outcomes across the region 2. Resource-Stratified Guidelines: Creating agreed treatment protocols tailored to local budgets and facilities, ensuring high standards of care without unnecessary expense 3. Training & Clinical Exchanges: Sharing expertise through joint surgical workshops, combined virtual tumour boards, and specialist oncology nursing training 4. Joint Drug Procurement: Working together to buy quality-tested biosimilars and essential cancer drugs in bulk, reducing medicine shortages and cutting out-of-pocket costs for families.
Conclusion
By joining forces across South Asia, countries can pool resources, reduce delays, and improve breast cancer survival for all women in the region.