Tomohiro Matsuda

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.

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.

Trends in 5-year net survival for women diagnosed with breast, cervical or ovarian cancer in Japan, 2000–14 (CONCORD-3)

Abstract Background Breast, cervical and ovarian cancers significantly affect young and middle-aged women, both physically and socially. However, relevant comprehensive stratified analyses are limited. Using Japanese data from CONCORD-3, a global cancer survival surveillance program, we analyzed long-term survival trends. Methods Data from 16 Japanese population-based cancer registries were analyzed for women diagnosed aged 15–99 years during 2000–2014 with a tumor originating in the breast, cervix uteri or ovaries. Follow-up was extended to five years post-diagnosis or until December 31st, 2014. In situ tumors and death-certificate-only registrations were excluded. Five-year net survival was estimated with the Pohar Perme estimator by calendar period of diagnosis, morphology and stage, and age-standardized with International Cancer Survival Standard weights. Results During 2000–2014, 5-year net survival improved for breast cancer from 85.9% (95% CI, 85.2–86.6%) to 89.4% (88.9–89.9%), for cervical cancer from 67.5% (66.3–68.7%) to 71.4% (70.4–72.3%), and for ovarian cancer from 35.5% (33.8–37.2%) to 46.3% (44.9–47.7%). Five-year survival for tumors diagnosed at a localized stage remained consistently high (>98% for breast cancer and > 90% for cervical cancer). Ovarian cancer survival varied greatly according to morphology. Conclusions Five-year net survival for women with cancers of the breast, cervix, and ovary) in Japan improved during 2000–2014, and remained at a globally high level throughout this period. These gains are probably attributable to earlier detection of breast and cervical cancers and advances in multimodal treatment for all cancers. Survival for distant-stage cervical and ovarian cancers remains a challenge, underscoring the need for enhanced screening and treatment strategies.