An Epidemiological Study of Cervical and Breast Screening in India: District-Level Analysis

Abstract Background: Breast cancer and cervical cancer, the most common forms of cancer in women worldwide, are on a fast and steady rise, accounting for more deaths in women than any other cancer in the developing world. Cancer screening tests are an important tool to combat cancer-related morbidity and mortality. The World Health Assembly, in its agenda for cancer prevention and control in the context of an integrated approach, urges governments and the WHO to accelerate action to achieve Goal 3.4 of the Sustainable Development Goals (SDG 3.4) in order to reduce premature mortality from non-communicable diseases including cancer by one-third by 2030 (WHO, 2016). Methods: Until recently, there was no evidence pertaining to screening for cervical and breast cancers at the national level. The National Family Health Survey, 2015-16 (NFHS-4), for the first time in the NFHS series, collected information on examination of the breast and the cervix from over 699,000 women in the age group 15-49 years. For the present study, the data was aggregated for all 640 districts in India. Moran’s Index was calculated to check for spatial autocorrelation. Univariate Local Indicators of Spatial Association (LISA) maps were plotted to look for spatial dependence associated with the uptake of screening practices. The spatial error model was employed to check for spatial magnitude and direction. Results: The factors associated with uptake of cervical and breast screening at the district level were: belonging to a general caste, residing in rural areas, being currently married, and being well-off economically. The study provides spatial inference by showing geographical disparities in screening, this study highlights the importance of ensuring a region-specific and organ-specific approach toward control and prevention of cancer. Conclusions: As part of the National Health Mission, the Indian government for the first time has launched population-based prevention, screening, and control programs for cancers of the cervix and the breast. The spatial analysis presented here may add essential information in policy-making. By showing geographical disparities in screening, this study highlights the importance of ensuring a region-specific and organ specific approach toward control and prevention of cancer.