Abstract
BackgroundBreast cancer incidence rates are increasing in developing countries including India. With 1.3 million new cases of cancer been diagnosed annually, breast cancer is the most common women’s cancer in India. India’s National Family Health Survey (NFHS-4) data 2015–2016 shows that only 9.8% of women between the ages of 15 and 49 had ever undergone breast examination (BE). Further, access to screening and treatment is unequally distributed, with inequalities by socio-economic status. It is unclear, however, if socio-economic inequalities in breast examination are similar across population subgroups.MethodsWe compared BE coverage in population sub-groups categorised by place of residence, religion, caste/tribal groups, education levels, age, marital status, and employment status in their intersection with economic status in India. We analysed data for 699,686 women aged 15–49 using the NFHS-4 data set conducted during 2015–2016. Descriptive (mean, standard errors, and confidence intervals) of women undergoing BE disaggregated by dimensions of inequality (education, caste/tribal groups, religion, place of residence) and their intersections with wealth were computed with national weights using STATA 12. Chi-square tests were performed to assess the association between socio-demographic factors and breast screening. Additionally, the World Health Organisation’s Health Equity Assessment Toolkit Plus was used to compute summary measures of inequality: Slope index for inequality (SII) and Relative Concentration Indices (RCI) for each intersecting dimension.ResultsBE coverage was concentrated among wealthier groups regardless of other intersecting population subgroups. Wealth-related inequalities in BE coverage were most pronounced among Christians (SII; 20.6, 95% CI: 18.5–22.7), married (SII; 14.1, 95% CI: 13.8–14.4), employed (SII: 14.6, 95%CI: 13.9, 15.3), and rural women (SII; 10.8, 95% CI: 10.5–11.1). Overall, relative summary measures (RCI) were consistent with our absolute summary measures (SII).ConclusionsBreast examination coverage in India is concentrated among wealthier populations across population groups defined by place of residence, religion, age, employment, and marital status. Apart from this national analysis, subnational analyses may also help identify strategies for programme rollout and ensure equity in women’s cancer screening.
Highlights
Breast cancer incidence rates are increasing in developing countries including India
We found that the percentage of women belonging to ‘poorest category’ in rural dwellings was 9 times greater than those in urban dwellings
The poorest quintile had a disproportionate concentration of uneducated, Schedule tribe (ST) and unemployed women while the richest quintile had more of urban, Sikh/Buddhist/other religion, general caste, highly educated and employed women
Summary
Breast cancer incidence rates are increasing in developing countries including India. BrCa can be detected at earlier stages by simple breast examination and is treatable, most Brca cases are diagnosed very late [5]. This is a matter of great concern in LMICs where BrCa often results in higher morbidity and financial constraints to households as compared to high income countries. India’s National Family Health Survey (NFHS-4) data 2015–2016 for the first time collected data on BrCa screening: it found that only one in ten women between the ages of 15 and 49 in India had ever undergone breast examination [9]
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