# Determinants of Cancer Screening in India: An Epidemiological Overview

## TL;DR

This study examines cancer screening rates and their determinants in India, finding very low coverage and identifying factors that influence screening behavior.

## Contribution

The study identifies sociodemographic and behavioral determinants of cancer screening in India using nationally representative data.

## Key findings

- Only 1.2% of women in India reported cervical cancer screening, with similarly low rates for breast and oral cancers.
- Exposure to health messages via TV and radio, higher BMI, and spouse's education were linked to increased screening.
- High parity, rural residence, and breastfeeding were associated with lower screening uptake.

## Abstract

Background: Noncommunicable diseases (NCDs) have emerged as a major global health burden. Among these, cancer is the second leading cause of mortality worldwide and accounts for a substantial proportion of deaths in India. This study aimed to evaluate state-specific disparities in breast, cervical, and oral cancer screening coverage and to identify determinants of cancer screening patterns.

Methods and materials: Data relevant to the study objectives were obtained from the fifth National Family Health Survey, which follows a cross-sectional study design. For analysis, only women aged 15-49 years were included. The primary outcomes of interest were self-reported screening behaviors for cervical, breast, and oral cancers. Responses were dichotomized as “yes” (screened) or “no” (not screened). Three separate models, each focusing on a distinct set of independent variables, were used to assess determinants of cancer screening behavior. Associations between outcome and predictor variables were examined using chi-square tests. Logistic regression models were used to estimate the likelihood of undergoing various cancer screening tests in relation to selected independent variables.

Results: This study revealed alarmingly low cancer screening rates in India. At the national level, only 1.2% (n = 2,642) of women reported screening for cervical cancer, 0.6% (n = 1,421) for oral cancer, and 0.5% (n = 1,230) for breast cancer.

Conclusions: Exposure to health-related messages through television and radio was positively associated with cancer screening uptake. Higher body mass index and the spouse's educational status were also positive predictors of screening participation. In contrast, high parity, current breastfeeding status, and rural residence were associated with lower screening uptake. The history of terminated pregnancy, employment status, and exposure to print media were not significant influencers. To address sociodemographic disparities in screening coverage, targeted interventions, such as mobile screening units in underserved rural areas, strengthened primary healthcare services, and community-based outreach through frontline health workers, should be prioritized. Additionally, culturally tailored awareness campaigns and strengthened referral linkages may further enhance screening uptake among disadvantaged populations.