Integrating breast cancer early detection into existing women's health service platforms in sub-Saharan Africa: a scoping review

Breast cancer is the most commonly diagnosed cancer among women in sub-Saharan Africa (SSA), where the majority of cases present at advanced stages and dedicated, population-wide screening programmes are largely absent. Organised mammographic screening is not feasible across most of the region because of limited imaging infrastructure, workforce shortages and cost, so resource-stratified guidance prioritises earlier, more attainable steps such as breast awareness and clinical breast examination linked to reliable diagnosis and treatment. A central implementation question follows: through which service contacts can early detection realistically reach women who would otherwise never attend a stand-alone screening visit? Service integration offers one answer. Attaching breast early detection to women's health platforms that women already use, such as cervical cancer screening, family planning, antenatal and postnatal care, immunisation, and HIV testing and treatment, can reduce the time, travel and cost of an additional visit and can share scarce staff and supervision. This logic is well developed for cervical cancer screening, whose integration into reproductive, maternal and HIV services has been mapped and identified as an effective health-system strategy. The breast equivalent has not been synthesised. Existing SSA reviews address screening modalities, individual-level determinants and barriers, single-country service-delivery factors, a demographic-specific screening model, and post-presentation diagnostic and treatment delays, but none takes the integration or co-delivery of breast early detection within existing women's health platforms as its object of study. This scoping review aims to map the nature, extent and reported outcomes of that integration in SSA. It addresses three questions: into which existing women's health platforms breast early detection has been integrated; what delivery models, workforce arrangements and referral pathways have been used; and what outcomes have been reported, including reach and uptake, linkage to diagnosis, stage at presentation and implementation measures. The review follows the Arksey and O'Malley framework with the Levac and Joanna Briggs Institute refinements, and is reported in line with PRISMA-ScR. Eligibility is defined using the Population, Concept and Context framework: women eligible for breast early detection; integration or co-delivery of a breast early-detection service (clinical breast examination, breast ultrasound, mammography, handheld breast-examination devices, or structured breast awareness) within an existing women's health platform; and any SSA country at any level of the health system. PubMed, Embase, Scopus, Web of Science, CINAHL, the African Index Medicus and African Journals Online are searched from January 2000 onwards, alongside grey literature, with reference-list hand-searching. Records are screened in duplicate in Rayyan, charted on platform type, delivery model, setting and reported outcomes, appraised using the Mixed Methods Appraisal Tool, and assessed for certainty using a GRADE-informed approach. Expected outcomes are a consolidated map of how breast early detection has been integrated into women's health services across SSA, identification of the dominant and underused host platforms, a synthesis of facilitators and barriers across the screening-to-diagnosis pathway, and a clear delineation of evidence gaps, particularly the scarcity of standardised outcomes such as stage at diagnosis and referral completion. The review is intended to inform programme design and to direct future research toward the platforms and outcome measures most likely to establish whether integration improves early detection and reduces late-stage presentation.