79 Background: Due to the lack of structured breast cancer screening programs in developing countries early detection is generally based on international western criteria. This principle is not valid in many instances since women withdraw from voluntary involvement in such activities. In addition breast cancer in developing countries is characterized by younger age and advanced disease at the initial presentation. This review aims to identify the suitable screening age for women in developing countries in order to develop a reliable national structured screening programs. Methods: This retrospective study was undertaken at King Fahd Hospital of the University, eastern province of Saudi Arabia between 1984-2010. Medical records of patients diagnosed with from the outpatient department and hospital admission records was reviewed. It mainly focused on demographic data and the time of presentation. Radiological and histo-pathological records were also reviewed. Results: The total number of patients reviewed was 483. The majority of patients were within the reproductive age group. Considering the standard screening age is 40 years, patients are divided into two groups, group I included those below the age of 40 years accounting for 193 patients (40%), while group II above the age of 40 years accounting for 290 patients (60%). Patients in group I were mostly reassured and were mainly diagnosed initially using ultrasonography, while in group II mammography aided in diagnosis. Conclusions: Despite the undisputable concept that breast cancer has higher predilection for women above the age of 40 years, yet in developing countries, a substantial subset of affected younger women contradicts this concept. The need for breast cancer screening cannot be overemphasized, yet, international screening guidelines for breast cancer cannot be fully implemented in developing countries. Therefore, it is mandatory that screening programs should be tailored according to individual communities. Dropping the screening age by a decade may possibly increase the capture of early breast cancer and improve the outcome.