Socio-economic and health access determinants of breast and cervical cancer screening in low-income countries: analysis of the World Health Survey

PLoS One. 2012;7(11):e48834. doi: 10.1371/journal.pone.0048834. Epub 2012 Nov 14.


Background: Breast and Cervical cancer are the two most common cancers among women in developing countries. Regular screening is the most effective way of ensuring that these cancers are detected at early stages; however few studies have assessed factors that predict cancer screening in developing countries.

Purpose: To assess the influence of household socio-economic status (SES), healthcare access and country level characteristics on breast and cervical cancer screening among women in developing countries.

Methods: Women ages 18-69 years (cervical cancer screening) and 40-69 years (breast cancer screening) from 15 developing countries who participated in the 2003 World Health Survey provided data for this study. Household SES and healthcare access was assessed based on self-reported survey responses. SAS survey procedures (SAS, Version 9.2) were used to assess determinants of breast and cervical cancer screening in separate models.

Results: 4.1% of women ages 18-69 years had received cervical cancer screening in the past three years, while only 2.2% of women ages 40-69 years had received breast cancer screening in the past 5 years in developing countries. Cancer screening rates varied by country; cervical cancer screening ranged from 1.1% in Bangladesh to 57.6% in Congo and breast cancer screening ranged from 0% in Mali to 26% in Congo. Significant determinants of cancer screening were household SES, rural residence, country health expenditure (as a percent of GDP) as well as healthcare access.

Discussion: A lot more needs to be done to improve screening rates for breast and cervical cancer in developing countries, such as increasing health expenditure (especially in rural areas), applying the increased funds towards the provision of more, better educated health providers as well as improved infrastructure.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / prevention & control
  • Developing Countries
  • Early Detection of Cancer / economics*
  • Female
  • Global Health
  • Health Services Accessibility / economics*
  • Health Surveys
  • Humans
  • Mammography
  • Mass Screening / economics*
  • Middle Aged
  • Poverty
  • Socioeconomic Factors
  • Uterine Cervical Neoplasms / diagnosis*
  • Uterine Cervical Neoplasms / prevention & control
  • Vaginal Smears

Grant support

This work was supported by the University of Michigan Rackham Merit Fellowship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.