Transforming Breast Cancer Control in East Africa by Integrating Cytomorphology and Genetics Into National Policy

The traditional approach to breast cancer control in Sub-Saharan Africa and East Africa has long been hindered by a reactive healthcare model that prioritizes symptomatic management over early, risk-stratified interventions. Drawing upon a multi-year research program conducted in Kenya that investigated cytomorphological patterns, epidemiological risk factors, and BRCA1/2 mutations, this perspective argues for a fundamental shift in national health policy. We propose that the current siloed diagnostic pathway may not be sufficient for the unique Kenyan and East African breast cancer phenotype, which is characterized by aggressive biology and early-onset presentation. This paper recommends repositioning fine-needle aspiration cytology (FNAC) as a triage tool followed by integration of genetic screening into the primary care framework. With this, East Africa can progressively move from a state of diagnostic delays to a model of precision public health.