Soumen Das Details Systemic Delays in Breast Cancer Care

Cancer care pathways across low- and middle-income countries face bottlenecks as patients routinely arrive at advanced disease stages, according to discussions at the Community Oncology Global Congress 2026. Organized by OncoDaily, the congress highlighted how delays build across every step of the patient journey, stretching from initial symptom recognition to final treatment initiation.

The Scale of Late Presentation in Breast Cancer

Breast cancer accounts for approximately 2.3 million new diagnoses globally each year, yet survival rates vary sharply depending on geography. Soumen Das, Head of the Breast Institute and the Department of Surgical Oncology at NCRI Hospital in Kolkata, India, noted during the congress that while five-year survival exceeds 95% in countries like the United Kingdom and the United States, it drops to roughly 65% in India and falls even lower in rural regions.

Data presented at the session show that between 40% and 60% of patients in low- and middle-income countries still present with stage III or IV disease. Das explained that this disparity cannot be attributed to biology alone, pointing instead to systemic delays that prevent timely diagnosis and intervention.

Breaking Down the Patient Delay Timeline

Medical delays in cancer care are categorized into distinct phases that span the entire patient experience. Primary delay occurs between the moment a patient notices a symptom and when they first seek medical attention. Secondary delay begins after a patient reaches a healthcare provider and continues until an appropriate diagnostic or treatment pathway is established. Tertiary delay takes place after a diagnosis is confirmed, when health-system factors stall the start of treatment. Finally, quaternary delay happens when patients bounce between multiple doctors or hospitals, occasionally turning to alternative medicine or seeking endless opinions rather than following a structured treatment plan.

While public health messaging often focuses primarily on patients waiting too long to seek help, findings discussed at the congress reveal a substantial burden of secondary delay. In some evaluated series, more than three months elapsed between a patient’s first consultation and an eventual diagnosis, while the median tumor size at presentation hovered around 3.5 cm.

Shifting Priorities Toward Clinical Examination

In high-income settings, population-wide mammographic screening routinely identifies tiny lesions measuring below 1 cm. However, in regions where the median tumor size at diagnosis reaches 3.5 to 4 cm, relying solely on mammography misses the immediate opportunity provided by larger, palpable tumors.

The congress panel emphasized that strengthening clinical breast examination can yield a more immediate impact in resource-limited environments than waiting for universal mammographic screening infrastructure to scale. Structured tools like BC-RADS can standardize clinical breast examinations, helping providers determine whether a patient requires reassurance, routine follow-up, or a fast-track referral.

The discussions featured contributions from Deepak Poudel, Associate Professor in the Department of Otorhinolaryngology and Head and Neck Surgery at B. P. Koirala Institute of Health Sciences in Dharan, Nepal, alongside Das, underscoring that fixing community-level detection and referral breakdowns remains essential to closing the global cancer survival gap.