Abstract
BackgroundCancer screening awareness and participation may be lower in low- and middle-income countries that lack established national screening programmes compared with those that do. We evaluated potential determinants of awareness about and participation in breast and cervical cancer screening, and breast self-examination (BSE) in women using survey data from Indonesia.MethodsFrom the fifth Indonesian Family Life Survey (2014–2015), a total of 5397 women aged 40 and older without any history of cancer who responded to questionnaires concerning Pap smears, mammography, and BSE were included. Multilevel modelling was used to assess potential determinants in relation to awareness about Pap smears and mammography, and participation in Pap smears and BSE practice. Multivariable analyses were performed to identify independent predictors of cancer screening.ResultsOf the 5397 respondents, 1058 (20%) women were aware of Pap smears, of which 297 had never had the procedure. Only 251 (5%) participants were aware of mammography. A total of 605 (12%) of women reported they performed BSE. Higher education and household expenditure were consistently associated with higher odds of awareness about Pap smears and mammography (e.g. odds ratio [OR] of being aware of Pap smear and mammography: 7.82 (95% CI: 6.30–9.70) and 7.70 (6.19–9.58), respectively, for high school graduates compared to women with less educational attainment in the multivariable models), and participation in Pap smears and BSE. We also identified enabling factors linked with greater cancer screening awareness and participation, including health insurance, shorter distance to health services, and social participation.ConclusionThere are socioeconomic disparities in cancer screening awareness and participation among Indonesian women. Our findings may help inform targeted health promotion and screening for cancer in the presence of limited resources.
Highlights
Cancer screening awareness and participation may be lower in low- and middle-income countries that lack established national screening programmes compared with those that do
We present the demographic characteristics of women who did not respond to questions on cancer screening (Additional file 1: Table S1), which comprised 9.6% of women aged 40 and older
We found higher odds of being aware of mammography in women living in urban areas (OR: 4.51, 95% CI: 3.36–6.06), women who had graduated high school (OR: 7.70, 6.19–9.58), women with higher household expenditure (OR: 2.28, 1.88–2.76), women that do physical activity (OR: 1.54, 1.24–1.90), women who have greater agreeableness (OR: 1.67, 1.33–2.09), women with neuroticism traits (OR: 1.24, 1.03–2.09), women who have insurance (OR: 2.01, 1.65–2.44), and women who participate in social activities (OR: 2.29, 1.62–3.23) (Table 4)
Summary
Cancer screening awareness and participation may be lower in low- and middle-income countries that lack established national screening programmes compared with those that do. We evaluated potential determinants of awareness about and participation in breast and cervical cancer screening, and breast selfexamination (BSE) in women using survey data from Indonesia. 2030, with 70% of those cases in low- to middle-income countries (LMICs) [2,3,4]. Cancer mortality rates have declined in high-income countries, LMICs have seen elevated cancer-related mortality rates [5], owing to a lack of cancer prevention and screening programmes and limited resources to treat cancer [4, 6]. In LMICs such as Indonesia, cancers are mostly diagnosed at an advanced stage, in which curative treatment is often no longer possible [7]. Breast and cervical cancers remain the leading causes of cancer mortality in Indonesia (21% and 10%, respectively) [5].
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