Breast cancer is the leading cause of cancer-related deaths among women, and Indonesia faces high mortality rates due to late diagnoses. Despite awareness, only 25% of Indonesian women undergo mammography because of financial barriers, lack of government funding, and cultural beliefs. This study of Ajeng Icanervilia assessing the effectiveness of clinical breast examination (CBE), mammography, and ultrasonography found clinical breast examination (CBE) to be sub-optimal in detecting malignant cases. Therefore, CBE alone should not replace mammography in screening protocols.
A systematic review of economic evaluations on mammography in low- and middle-income countries (LMICs) found mammography to be cost-effective in 18 out of 21 studies, particularly in upper middle-income nations. Although Indonesia is an upper middle-income country, mammography is not part of the Indonesian national screening program plan. For introducing of a new health intervention, the government requires a cost-effectiveness analysis (CEA) as part of a health technology assessment. A CEA study showed that mammography screening is cost-effective compared to no screening under the following conditions: (a) screening women aged 40-65 every 4 years at 50% participation rate, (b) screening women aged 40-65 every 4 years at 70% participation rate, (c) screening women aged 40-65 every 3 years at 70% participation rate, (d) screening women aged 40-65 every 2 years at 70% participation rate.
Based on these findings, mammography is a cost-effective, well-recognized, and well-accepted strategy for breast cancer screening in Indonesia. The government should prioritize early detection initiatives, allocate resources to screening, and strengthen healthcare systems to ensure timely diagnosis and treatments.
