October is Breast Cancer Awareness Month. According to WHO, breast cancer is the most commonly diagnosed cancer in women worldwide, with over 2 million new cases a year. Survival differs enormously between countries: in high-income countries, most women survive at least five years, while in many low- and middle-income countries, survival is much lower, largely because women are diagnosed at a late stage. Nurses and midwives, who see women at antenatal clinics, family planning, immunisation and outpatient visits, are well placed to change that.
The WHO Global Breast Cancer Initiative
WHO’s Global Breast Cancer Initiative aims to reduce breast cancer deaths by 2.5% a year, through three pillars:
- Health promotion for early detection: aiming for at least 60% of invasive cancers to be diagnosed at an early stage.
- Timely diagnosis: within 60 days of first presentation.
- Comprehensive treatment: at least 80% of patients completing recommended treatment.
Warning signs to teach
- A new lump or thickening in the breast or armpit, often painless.
- Change in the size or shape of a breast.
- Dimpling or puckering of the skin; skin that looks like orange peel.
- Change in the nipple: turned in (inverted), rash or crusting.
- Unusual nipple discharge, especially bloody.
- Persistent pain in one part of the breast or armpit.
Most breast lumps are not cancer, but every new lump should be checked by a health worker. Breast cancer can also affect men, though rarely.
Breast awareness
Many health systems now promote breast awareness rather than a strict monthly self-examination routine: knowing how your breasts normally look and feel, so you notice changes and get them checked quickly. Nurses can teach women to look in a mirror with arms down and raised, and to feel the whole breast and armpit with the flat of the fingers, in a way that works for them.
Clinical breast examination
Where mammography isn’t widely available, clinical breast examination (CBE) by trained health workers, including nurses, is an important early detection tool for women with symptoms or at higher risk. Trained nurses inspect and palpate both breasts and armpits systematically, document findings, and refer any abnormality quickly. Ask your facility about CBE training.
Screening
In countries with organised programmes, women are invited for mammography at set ages: for example, every 3 years from age 50 to 71 in England, and every 2 years from age 40 in the latest US Preventive Services Task Force recommendation. Women with a strong family history or known gene changes (such as BRCA1/2) may need earlier or additional screening. Follow your national guidelines.
Breaking down barriers to early diagnosis
- Fear and fatalism: many women delay because they believe cancer is a death sentence. Explain that early breast cancer is often curable.
- Belief in alternative causes or cures: some women try herbal or spiritual treatment first. Engage respectfully, and encourage seeing a health worker alongside.
- Cost and distance: help women navigate referral pathways and support schemes.
- Fear of losing a breast: explain that treatment options vary, and that support is available.
- Young women: breast cancer in Africa often affects younger women than in Europe and North America, so symptoms in women under 40 should not be dismissed.
Reducing risk
- Breastfeeding lowers the risk.
- Maintaining a healthy weight, physical activity, and limiting alcohol.
- Discussing family history with a health worker.
Supporting women through treatment
Oncology and breast care nurses support women through surgery, chemotherapy, radiotherapy and hormonal therapy: managing side effects, providing information, and helping with body image, sexuality, work and family. Specialist breast care nurses are a recognised role in many countries and are in short supply in Africa. See our guide on how to become an oncology nurse and our report on Nigeria’s oncology nurse shortage.
Based on WHO breast cancer fact sheets and the WHO Global Breast Cancer Initiative, NHS breast screening information and USPSTF recommendations (2024). Educational content: follow your national guidelines.