This review highlights the increasing incidence of breast cancer world-wide and the increasing burden of breast cancer deaths experienced by lower-income countries. The causes of increasing incidence have been attributed to changes in the prevalence of reproductive risk factors, lifestyle changes, and genetic and biological differences between ethnic and racial groups. All these factors may contribute, but data linking etiological factors to increased risk in developing countries is lacking. The challenge for lower-income countries is developing effective strategies to reverse the trend of increasing mortality. Down-staging of breast cancer by early detection is a promising long-term strategy for preventing disease-related deaths but it is difficult to make the economic investment required to carry out broad screening programs. Successful strategies for addressing the growing breast cancer burden will therefore take political will, reliable data, public and medical community awareness, and partnerships between community advocates, governments, non-governmental organizations and biotechnology.