Inventory and needs assessment in francophone LMICs for education, screening and optimal management of breast cancer. The ELISA study.

[INTRODUCTION] Breast cancer management in francophone Low- and Middle-Income Countries (LMICs) faces critical challenges due to limited diagnostic and therapeutic resources. The ELISA Project conducted a comprehensive needs assessment to identify priority interventions for improving care in these regions.

[METHODS] A structured web-based questionnaire was completed by 105 oncology practitioners across 13 francophone LMICs, including 76 from North Africa and 29 from Sub-Saharan Africa. The survey quantitatively assessed availability and barriers across the cancer care continuum, from screening to treatment. Responses were analyzed using descriptive statistics.

[RESULTS] The study revealed profound systemic gaps in breast cancer services. Organized screening programs were reported by only 25% of respondents as being available in their country. Advanced diagnostic capabilities were severely limited, with 70-80% of respondents reporting inadequate access to MRI and prolonged pathology turnaround times of 4-8 weeks. Radiotherapy services were particularly deficient, described as poor by 73% of participants, with fewer than 15% having capacity for modern techniques like intensity-modulated radiotherapy (IMRT). Novel targeted therapies such as CDK4/6 inhibitors were reported as adequately available by only 15% of respondents. Crucially, 80% of healthcare providers identified enhanced training programs and strengthened multidisciplinary collaboration as fundamental requirements for service improvement.

[DISCUSSION] These findings expose critical inequities in breast cancer care capacity across francophone LMICs, characterized by infrastructure limitations and financial barriers. The results underscore the urgent need for context-appropriate solutions including screening program development, strategic equipment investments, and international training initiatives to reduce disparities in cancer outcomes.