Breast cancer now tops incidence rankings in much of sub-Saharan Africa, yet most countries lack nationally endorsed diagnostic reference levels (DRLs) for mammography. This narrative review synthesizes the dosimetric foundations of mammography dose metrics, maps international DRL values published since 2018, and examines why Cameroon, despite a rising cancer burden and IAEA-supported regulatory reform, has not translated optimization principles into practice. Three questions guided the work: what quantities and conversion formalisms underpin mammography DRLs; how comparable are current international values given methodological heterogeneity; and what structural, technical, and human-resource barriers obstruct implementation in Cameroon, along with a phased roadmap that is feasible rather than aspirational. A systematic search of PubMed, Scopus, Web of Science, and grey literature from the IAEA, ICRP, and the Cameroonian Ministry of Public Health yielded 58 primary sources. The evidence shows wide variation in reported DRLs, driven by phantomversus patient-based protocols, thickness stratification choices, and the transition from 2D digital mammography to digital breast tomosynthesis, while Cameroon faces an almost complete absence of calibrated dosimetry equipment, clinically qualified medical physicists, and a national dose registry. A pragmatic six-phase pathway is proposed, beginning with an equipment census and phantom-based pilot at four to six centers, progressing through provisional local DRLs to regulatory adoption and regional harmonization via the AFRA network. The review concludes that sustainable DRL implementation in resource-limited settings demands phased investment in metrology infrastructure and workforce development before national values can be meaningfully set.