Application of Cancer Screening Guidelines in Resource Limited Settings

Cancer screening is increasingly promoted as a public health intervention, yet its effective translation with demonstrable impact on disease burden remains limited in low resource settings due to the suboptimal implementation of guidelines. While evidence from high-income countries and settings have informed international guidelines, the direct application of these recommendations often overlooks the realities of under-resourced settings, where diagnostic infrastructure, referral pathways, and treatment capacity are fragmented and inadequate. Moreover, the societal and health belief systems in many societies are different from high income country settings where screening was well received. This perspective provides a critical look at cancer screening with a focus on breast, cervical, colorectal, and oral cancers in low- and middle-income countries (LMICs) and draws on global and national guidelines and capacity to highlight gaps in implementation and system preparedness. Considerable variation exists across countries in terms of eligible age groups, test modalities, and screening intervals, reflecting both contextual adaptation and the challenges of aligning evidence with feasibility. Emerging innovations, including digital technologies and artificial intelligence, offer potential benefits but raise important concerns related to validation, ethical use, and equity of access. Ultimately, cancer screening can serve as a "best buy" intervention only if countries invest in strengthening early diagnosis and treatment pathways, ensure system readiness, and adopt phased implementation strategies tailored to local contexts. Without such preparedness, large-scale screening risks misallocation of scarce resources without measurable impact on the disease burden.