Breast Cancer in Bosnia and Herzegovina: What Do Diagnostic and Treatment Patterns Tell Us About Survival?

Background Timely diagnosis is critical for improving breast cancer outcomes, especially in resource-limited health systems. This study provides the first real-world evidence from Bosnia and Herzegovina on diagnostic and treatment intervals, adherence, and survival in women with breast cancer. Methods We conducted a retrospective analysis of breast cancer cases diagnosed between 2019 and 2023 at the Clinical Centre University of Sarajevo, the largest cancer center in the country, managing approximately 60% of cases in the Federation of Bosnia and Herzegovina. Results Most patients (78.1%) were diagnosed through self-referral due to symptoms, with 62.4% of cancers detected at stages 1 and 2. Mean patient and system diagnostic intervals were similar (38.1 days, 95% CI 43.4–52.8; 38.6 days, 95% CI 29.9–47.3, respectively), with a total diagnostic interval of 70 days (95% CI 58.9–82.5). Almost all diagnostic procedures had a waiting time of less than ten days. Radical mastectomy was performed in 61% of all women (95% CI 55–66) and 55% (95% CI 48–62) of women with stage 1–2 disease undergoing surgery. Treatment duration averaged 3.7 months for chemotherapy (95% CI 3.4–4.1) and 0.48 months for radiotherapy (95% CI 0.26–0.69), with higher compliance for radiotherapy (99.5%, 95% CI 98–100) than chemotherapy (78%, 95% CI 72–84). Three-year progression-free survival was 85.7% (95% CI 79.9–91.9), and overall three-year survival was 86% (95% CI 80.5–91.9). Conclusions Efficient diagnostic organization can achieve early breast cancer detection and favorable survival even in resource-constrained settings.