© 2019, Springer Science+Business Media, LLC, part of Springer Nature. Purpose of Review: Breast cancer is the most common cancer and a leading cause of cancer death among women living in low- and middle-income countries (LMIC) despite declining mortality in high-income countries. The rising morbidity and mortality from breast cancer is fueled by a number of factors including late presentation, poor access to medical care, and less than optimal diagnostic and therapeutic capabilities. Reducing the breast cancer burden in LMICs will require improving early detection and overcoming barriers to accessing the health system as well as making diagnosis and treatment more affordable. While North American guidelines advocate for mammography as the most effective screening approach, most developing countries do not have ready access to the technology, nor the trained workforce needed to perform and interpret mammograms. Recent Findings: In this paper, we present perspectives from Tajikistan, Kenya, and Pakistan and report on efforts to address the burden of breast cancer through screening and early detection programs. Given the significant proportion of women diagnosed with breast cancer in LMICs who present pre-menopausally and with higher grade tumors, widespread screening mammography may not be the most cost-effective approach. Summary: Based on the current evidence and our experience in LMICs, we suggest an approach which prioritizes population-wide education and self and clinical breast exams as a cost-conscious intervention likely to result in a population-wide shift toward early detection and better survival rates from breast cancer.