Scaling global breast imaging outreach: strategic frameworks for overcoming barriers in uninsured and under-resourced populations

Breast cancer is the most commonly diagnosed cancer and a leading cause of cancer-related death in women worldwide. Despite advances in diagnostic imaging and targeted therapy, a substantial survival gap persists between high-income and low- and middle-income countries, as well as for uninsured groups within high-income countries, with five-year survival exceeding 90% in well-resourced settings but falling to 40% to 60% in resource-limited ones. This narrative review asks how a localized breast imaging outreach pilot might be transitioned into a sustainable, globally managed program (herein described as a conceptual model we term Chapter II) and synthesizes the structural and operational strategies relevant to implementing such a program. We conducted a narrative (non-systematic) review. Building on early outreach initiatives such as the RAD-AID Asha Jyoti mobile screening pilot in India, which demonstrated that high-quality imaging can be delivered to underserved communities, we examined the logistical, cultural, and financial barriers involved in scaling from a localized pilot to a sustained program and identified systems-level approaches described in the published literature and in global-health guidance. Recommendations are presented as a conceptual synthesis rather than as a validated framework. The literature and program experience reviewed suggest that closing the screening gap requires an integrated approach combining cloud-based teleradiology, community-integrated care models supported by public health nurses and sustained cross-border leadership. These strategies are proposed to address systemic delays in screening and diagnosis and to reduce loss to follow-up among under-resourced populations; the strength of the supporting evidence varies by component and is described in the text. By adopting these structural and operational strategies, radiologists and health care administrators can help close the breast cancer screening gap. The article familiarizes radiologists with the distinct challenges faced by uninsured and under-resourced populations, the disproportionate burden of late-stage diagnosis these groups experience, and the systems-level solutions that can deliver sustainable care where it is most needed.