International Institute for Population Sciences, Mumbai, India.
BMC Womens Health. 2020 Oct 7;20(1):225. doi: 10.1186/s12905-020-01083-6.
Breast cancer and cervical cancer, the most common forms of cancer in women worldwide, are on a fast and steady rise, accounting for more deaths in women than any other cancer in the developing world. Cancer screening tests are an important tool to combat cancer-related morbidity and mortality. World Health Organization aims to accelerate action to achieve Goal 3.4 of the Sustainable Development Goals (SDG 3.4) in order to reduce premature mortality from non-communicable disease, including cancer by one-third by 2030. This study aims to examine the geospatial variation of cervical and breast screening across districts and to identify factors that contribute to the utilization of screening among women in India.
Until recently, there was no evidence pertaining to screening for cervical and breast cancers at the national level. Information on examination of the breast and cervix from over 699,000 women aged 15-49 years was collected for the first time in the fourth round of National Family Health Survey, 2015-16 (NFHS-4). For the present study, the data were aggregated for all 640 districts in India. Moran's Index was calculated to check for spatial autocorrelation. Univariate Local Indicators of Spatial Association (LISA) maps were plotted to look for spatial dependence associated with the uptake of screening practices. The spatial error model was employed to check for spatial magnitude and direction.
The common factors associated with uptake of both cervical and breast screening at the district level were; women belonging to a general caste, residing in rural areas, being currently married, and being well-off economically. Being insured was positively associated with the uptake of cervical screening only. This study provides spatial inference by showing geographical variations in screening of cervix and breast across districts of India.
By showing geographical disparities in screening practices across districts of India, this study highlights the importance of ensuring a region-specific and organ-specific approach towards control and prevention of cancer. The identified factors responsible for the uptake of screening could be a guiding force to decide how and where tailored interventions may be best targeted.
乳腺癌和宫颈癌是全球女性最常见的癌症类型，在发展中国家导致的女性死亡人数超过其他任何癌症。癌症筛查测试是对抗与癌症相关的发病率和死亡率的重要工具。世界卫生组织旨在加速行动，实现可持续发展目标 3.4 目标，到 2030 年，将包括癌症在内的非传染性疾病导致的过早死亡率降低三分之一。本研究旨在检查印度各地区宫颈癌和乳腺癌筛查的地理空间差异，并确定导致妇女利用筛查的因素。
直到最近，在国家一级都没有关于宫颈癌和乳腺癌筛查的证据。在 2015-16 年第四次国家家庭健康调查（NFHS-4）中，首次收集了 699,000 名 15-49 岁妇女乳房和宫颈检查的信息。在本研究中，将印度所有 640 个地区的数据汇总。计算 Moran 指数以检查空间自相关。绘制单变量局部空间关联（LISA）图以寻找与筛查实践采用相关的空间依赖。采用空间误差模型检查空间幅度和方向。
与地区一级宫颈癌和乳腺癌筛查采用相关的共同因素是；属于普通种姓的妇女、居住在农村地区、目前已婚和经济状况良好。有保险与宫颈癌筛查的采用呈正相关。本研究通过显示印度各地区宫颈癌和乳腺癌筛查的地理差异提供了空间推断。
本研究通过显示印度各地区筛查实践的地理差异，强调了确保针对癌症控制和预防采取特定区域和特定器官方法的重要性。确定的采用筛查的因素可以作为决定如何以及在何处最好针对特定目标的干预措施的指导力量。
