# Clinical Breast Examination Uptake among Reproductive Aged Women in Zambia: Evidence from the 2024 Zambia Demographic and Health Survey

## TL;DR

This study finds that only 13% of reproductive-aged women in Zambia have ever had a clinical breast exam, with education, health insurance, and cervical cancer screening linked to higher uptake.

## Contribution

The study provides new evidence on CBE uptake and its determinants among reproductive-aged women in Zambia using the 2024 ZDHS data.

## Key findings

- Only 13.3% of women aged 15–49 in Zambia reported ever receiving a clinical breast examination.
- Women with higher education, health insurance, and cervical cancer screening were more likely to have had a CBE.
- Regional disparities in CBE uptake were observed, with women in Luapula and Copperbelt provinces more likely to be screened.

## Abstract

Breast cancer remains a major cause of mortality among women in sub-Saharan Africa driven, in part, by low screening coverage. We assessed the prevalence and determinants of clinical breast examination (CBE) uptake among reproductive-aged women in Zambia.

This cross-sectional study utilized data from 13,876 women aged 15–49 years who participated in the 2024 Zambia Demographic and Health Survey (ZDHS). The outcome variable was derived from participants’ response to ‘ever having had a breast examination by a health care provider.’ Descriptive statistics and survey-weighted logistic regression analyses were conducted in Stata, with all estimates adjusted to account for the complex survey design used in the ZDHS. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were reported.

Overall, 13.3% (n = 1,845) of women reported ever receiving CBE. Among those screened, the majority were aged 30–39 years (35.4%), resided in urban areas (56.5%), had secondary level education (42.7%) and belonged to the richest wealth quintile (30.5%). Furthermore, only 17.8% of screened women had health insurance, and two-thirds (66.2%) had previously undergone cervical cancer screening. Higher education (AOR = 1.58; 95% CI: 1.08–2.32) and health insurance coverage (AOR = 1.30; 95% CI: 1.04–1.62) were positively associated with CBE uptake. Women who had visited a health facility in the previous 12 months (AOR = 1.38; 95% CI: 1.18–1.61) and those ever screened for cervical cancer (AOR = 5.95; 95% CI: 5.18–6.84) had significantly greater odds of receiving CBE, while women living with HIV were less likely to be screened (AOR = 0.82; 95% CI: 0.69–0.98). Regional variation was observed with women in Central (AOR = 1.43; 95% CI: 1.10–1.88), Copperbelt (AOR = 1.42; 95% CI: 1.12–1.78), Luapula (AOR = 1.94; 95% CI: 1.39–2.72), and Northwestern (AOR = 1.33; 95% CI: 1.01–1.77) provinces having higher odds of CBE compared with those in Lusaka, while women in Eastern Province were less likely to receive CBE (AOR = 0.68; 95% CI: 0.49–0.95).

There is low utilization of CBE services among women aged 15–49 years in Zambia. Strategies which expand access and utilization of breast cancer screening services are warranted.