Patient journey and timeliness of care for patients with breast cancer in Africa: a scoping review

Timely access to breast cancer care is critical for improving prognosis and survival, but multiple barriers can lead to prolonged intervals across the care pathway. This scoping review aims to identify the methods used to measure timeliness in breast cancer care, pinpoint specific points in the care pathway where longer time intervals are most common and categorise the factors influencing the timeliness of care in Africa. Scoping review followed the methodological framework for scoping reviews outlined by Arksey and O'Malley. Five electronic databases, MEDLINE, EMBASE, CINAHL, Web of science, and PsycINFO, were searched for articles published between 1999 and 2024, and the Google search engine was used to search for grey literature. We included studies that measured time to presentation, diagnosis or treatment within the context of breast cancer care in Africa, and/or assessed one or more of these care intervals. Two reviewers independently screened relevant abstracts and full texts against the selection criteria. Key themes were then synthesised narratively based on a predefined theoretical framework adapted from the Model of Pathways to Treatment and Andersen's model of health service. The initial search identified 3552 articles, with 29 studies ultimately included for data charting. All the included studies drew samples from healthcare facilities. This review identified seven multidirectional key time points: symptom onset, recognising the need for help, engaging with informal care providers, presenting at a health facility, receiving a diagnosis, consulting a specialist and starting treatment. The review also revealed significant variation in the terminology used for time events and in the metrics defining time intervals. The time interval between symptom recognition and contact with a healthcare provider was the most frequently studied and was often longer than other intervals. In many African countries, traditional healers and spiritual sites were the first point of contact for many patients with breast cancer after noticing initial symptoms. There was a scarcity of research into completion of cancer treatment and follow-up, despite significant barriers in accessing and affording cancer care. This review highlights significant variation in how timeliness of breast cancer care are defined and measured across African countries, underscoring the need for standardised tools to assess care intervals. The predominance of facility-based studies may overlook patients who never reach formal healthcare settings, pointing to a critical gap in community-level evidence. These findings emphasise the importance of adopting a systems-based approach to improve breast cancer care, one that integrates both formal and informal care pathways and actively involves patients in navigating timely access to services.