Sarah Krull Abe

Regional Variations and Inequalities in Testing for Early Detection of Breast and Cervical Cancer: Evidence From a Nationally Representative Survey in India

The burden of cancer in India has been rising, yet testing for early detection remains low. This study explored inequalities in the uptake of breast cancer (BC) examination and cervical cancer (CC) among Indian women, focusing on socioeconomic, regional, and educational differences. Data from the 2019-21 National Family Health Survey (n = 353,518) were used to assess the uptake of BC examination and CC testing. Inequalities were quantified using the slope index of inequality (SII), relative index of inequality (RII), and relative concentration index (RCI). SII measured absolute inequality, while RII and RCI assessed relative inequality between disadvantaged and advantaged groups. The ever uptake of tests for early detection of BC and CC were low at 9 and 20 per 1,000 women, respectively. Higher uptake was observed among women from the richest households compared to the poorest (SII: 1.1 for BC and 1.8 for CC). The magnitude of relative socioeconomic inequalities was more pronounced in rural areas (RCI: 22.5 for BC and 21.3 for CC) compared to urban areas. Similarly, higher-educated women were 4.84 times (RII: 4.84) and 2.12 times (RII: 2.12) more likely to undergo BC examination and CC testing, respectively, compared to non-educated women. The Northeastern region exhibited greater socioeconomic inequality, while the Western region showed more education-based inequality. The lower uptake of BC examination and CC testing and the marked inequalities underscore the need for targeted interventions to improve access and utilization of testing services, especially among lower-educated women, and those in rural areas.

Prevalence of Cervical Cancer Screening in Asia: A Systematic Review and Meta-Analysis

Cervical cancer is one of the most common causes of cancer-related mortality among female, especially in the low-and-middle income countries. This systematic review and meta-analysis aimed to identifying the prevalence and trend of cervical cancer screening among 21member countries of the Asian National Cancer Centres Alliance (ANCCA)/ regions in Asia. We conducted a search on three databases including: PubMed, Web of Science and Scopus, using our search terms. Two independent reviewers screened titles and abstracts based on inclusion and exclusion criteria, and any conflicts were resolved through discussion. Full-text screening was also completed by two independent reviewers, and conflicts were resolved accordingly. Relevant information was extracted into an Excel sheet, and random-effects meta-analysis was performed to identify the pooled estimate of cervical cancer screening in Asia using Stata 17. The review has been registered in PROSPERO (registration ID: CRD42023401516). We identified 54 studies from 19 ANCCA member countries/ regions in Asia reporting cervical cancer screening rates between 2012-2023. The pooled estimate of eight countries (Bangladesh, China, India, Iran, Japan, Korea, Nepal, and Thailand) that had more than three data points and were rated as satisfactory to very good in the quality assessment showed that cervical cancer screening rate was around 28% (95% CI: 0.25 - 0.32) in the last ten years. Most of countries/regions in Asia do not have sufficient data on cervical cancer screening due to lack of nationally representative surveys or national level cancer registries. Hence, it is crucial to encourage governments and private sector to strengthen their capacities and work in collaboration to enhance the cervical cancer screening rate in their respective countries.

Disparities and Determinants of Testing for Early Detection of Cervical Cancer among Nepalese Women: Evidence from a Population-Based Survey

Abstract Background: Cervical cancer presents a considerable challenge in South Asia, notably in Nepal, where screening remains limited. Past research in Nepal lacked national representation and a thorough exploration of factors influencing cervical cancer screening, such as educational and socioeconomic disparities. This study aims to measure these gaps and identify associated factors in testing for early detection of cervical cancer among Nepalese women. Methods: Data from the 2019 Nepal Noncommunicable Disease Risk Factors survey (World Health Organization STEPwise approach to noncommunicable risk factor surveillance), involving 2,332 women aged 30 to 69 years, were used. Respondents were asked if they had undergone cervical cancer testing through visual inspection with acetic acid, Pap smear, or human papillomavirus test ever or in the past 5 years. The slope index of inequality (SII) and relative concentration index were used to measure socioeconomic and education-based disparities in cervical cancer test uptake. Results: Only 7.1% [95% confidence interval (CI): 5.1–9.9] Nepalese women had ever undergone cervical cancer testing, whereas 5.1% (95% CI: 3.4–7.5) tested within the last 5 years. The ever uptake of cervical cancer testing was 5.1 percentage points higher (SII: 5.1, 95% CI: −0.1 to 10.2) among women from the richest compared with the poorest households. Education-based disparities were particularly pronounced, with a 13.9 percentage point difference between highly educated urban residents and their uneducated counterparts (SII: 13.9, 95% CI: 5.8–21.9). Conclusions: Less than one in ten women in Nepal had a cervical cancer testing, primarily favoring higher educated and wealthier individuals. Impact: Targeted early detection and cervical cancer screening interventions are necessary to address these disparities and improve access and uptake.