Socio-economic and regional variation in breast and cervical cancer screening among Indian women of reproductive age: a study from National Family Health Survey, 2019-21

Abstract

Background In India, breast and cervical cancers account for two-fifths of all cancers and are predominantly prevalent among women in the reproductive age group. The Government of India recommended screening of breast and cervical cancer among women aged 30 years and over. This study examines the socio-economic and regional variations of breast and cervical screening among Indian women in the reproductive age. Methods A full sample of 707,119 women aged 15–49 and a sub-sample of 357,353 women aged 30–49 from National Family Health Survey-5 (2019-21) were used in the analysis. Self-reported ever screening for breast and cervical cancer for women aged 15–49 and women aged 30–49 were outcome variables. A set of socio-economic and risk factors associated with breast and cervical cancer screening were used as the predictors. Logistic regression was used to understand the significant correlates of cancer screening and, concentration index and concentration curve were used to assess the socio-economic inequality in breast and cervical cancer screening. Results The proportion of breast and cervical cancer screening among women aged 30–49 were 877 and 1965 per 100,000 women respectively. Cancer screening was lower among women who were poor, young, had lower educational attainment and resided in rural areas. The concentration index was 0.2 for ever screening of breast cancer and 0.15 for cervical cancer among women aged 30–49 years. The concertation curve for screening of both breast and cervical cancers was pro-rich. Women with higher educational attainment [OR:1.46, 95% CI: 1.31–1.62], aged 40–49 years [OR:1.35; 95% CI: 1.28–1.43], resided in the western [OR:1.62; 95% CI:1.4–1.87] or southern [OR:6.66; 95% CI:5.93–7.49] region had significantly higher odds of up taking either of the screening. The pattern of breast and cervical cancer screening among women aged 15–49 was similar to that of women 30–49. Conclusion The overall proportion of cancer screening among women in 30–49 age group is low in India. Early screening and treatment can reduce the burden of these cancers. Creating awareness and providing knowledge on cancer could be a key strategy for reducing the burden of breast and cervical cancers among women in the reproductive age in India.

Prevalence of Genotype Patterns Associated With High-Risk Human Papillomavirus in Cervical Lesions

“…Despite being preventable, cervical carcinoma has emerged as a devastating disease, making it imperative to understand the epidemiology of cervical cancer in India along with the prevalence of HPV genotypes which are crucial parameters to aim for its prevention. The HPV prevalence varies greatly across India among patients with cervical lesions [6,11,15] and is influenced by the geographical location, genetic variability of the viral genome, and sociodemographic factors affecting different HPV genotypes [8][9][10]17].…”

“…Persistent HR-HPV infection is a primary cause of cervical lesions [8,9]. As the western zone of the country is home to Asia's largest slum, poor hygiene, demographics, socioeconomic and structural barriers, and inadequate medical facilities are responsible for ineffective, organized, and opportunistic cervical cytology screening.…”

“…The prevalence of child marriages amounts to early age at marriage, early sexual activity, or early coitarche which become factors for the persistence and progression of HPV infection toward cervical cancer [9]. This zone of India exhibits a distinct cultural, climatic, and geographical landscape compared to other parts of the country.…”

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“…There is still a huge gap in the awareness among health care providers. [15][16][17] Availability of screening guidelines: Since BCSP was introduced very recently in the country, there are still no standard guidelines from national or state level. This creates friction in the system wherein both clinicians and citizens over or underuse screenings.…”

“…This creates friction in the system wherein both clinicians and citizens over or underuse screenings. 6,16 Availability of screening professionals: In India, prevention is considered least of clinical attraction for health care providers. Even if it is, this would be mostly focused on infection related diseases such as Malaria and other infections.…”