Subhojit Dey Subhojit Dey, Indian Institute of Public Health-Delhi, Gurgaon 122002, Haryana, India Author contributions: Dey S solely contributed to this paper. Correspondence to: Subhojit Dey, MBBS, MD(AM), MPH, PhD, Associate Professor, Indian Institute of Public Health- Delhi, Plot 47, Sector 44, Gurgaon 122002, Haryana, India. subhojit.dey@iiphd.org Telephone: +91-124-4781400 Fax: +91-124-4781601 Received: January 28, 2014 Revised: March 27, 2014 Accepted: June 10, 2014 Published online: August 10, 2014 Abstract To review the present status of breast cancer (BC) screening/early detection in low- and middle-income countries (LMICs) and identify the way forward, an open focused search for articles was undertaken in PubMed, Google Scholar and Google, and using a snowball technique, further articles were obtained from the reference list of initial search results. In addition, a query was put up on ResearchGate to obtain more references and ind out the general opinion of experts on the topic. Experts were also personally contacted for their opinion. Breast cancer (BC) is the most common cancer in women in the world. The rise in incidence is highest in LMICs where the incidence has often been much lower than high-income countries. In spite of more women dying of cancer than pregnancy or child- birth related causes in LMICs, most of the focus and resources are devoted to maternal health. Also, the majority of women in LMICs present at late stages to a hospital to initiate treatment. A number of trials have been conducted in various LMICs regarding the use of clinical breast examination and mammography in various combinations to understand the best ways of implementing a population level screening/early detec- tion of BC; nevertheless, more research in this area is badly needed for different LMIC speciic contexts. No- tably, very few LMICs have national level programs for BC prevention via screening/early detection and even stage reduction is not on the public health agenda. This is in addition to other barriers such as lack of aware- ness among women regarding BC and the presence of stigma, inappropriate attitudes and lack of following proper screening behavior, such as conducting breast self-examinations. The above is mixed with the apathy and lack of awareness of policy makers regarding the fact that BC prevention is much more cost-effective and humane than BC treatment. Implementation of popula- tion level programs for screening/early detection of BC, along with use of ways to improve awareness of wom- en regarding BC, can prove critical in stemming the increasing burden of BC in LMICs. Use of newer mo- dalities such as ultrasonography which is more suited to LMIC populations and use of mHealth for awareness creation and increasing screening compliance are much needed extra additions to the overall agenda of LMICs in preventing BC. © 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Breast cancer; Screening; Early detection; Mammography; Clinical breast examination; Breast self examination; Ultrasonography; Awareness; Developing countries; Low- and middle-income countries Core tip: Implementation of population level breast cancer (BC) screening/early detection programs will prove to be most cost-effective for low- and middle- income countries (LMICs). Accompanying awareness creation regarding BC among women, more research and change in policy are also necessary to reduce the burden of BC in LMICs. Dey S. Preventing breast cancer in LMICs via screening and/or early detection: The real and the surreal. World J Clin Oncol 2014; 5(3): 509-519 Available from: URL: http://www.wjg- TOPIC HIGHLIGHT Preventing breast cancer in LMICs via screening and/or early detection: The real and the surreal WJCO 5 th Anniversary Special Issues (2): Breast cancer Submit a Manuscript: http://www.wjgnet.com/esps/ Help Desk: http://www.wjgnet.com/esps/helpdesk.aspx DOI: 10.5306/wjco.v5.i3.509 World J Clin Oncol 2014 August 10; 5(3): 509-519 ISSN 2218-4333 (online) © 2014 Baishideng Publishing Group Inc. All rights reserved. World Journal of Clinical Oncology W JC O 509 August 10, 2014|Volume 5|Issue 3| WJCO|www.wjgnet.com