Rahman Md Mahfuzur, Rahman Md Shafiur, Islam Md Rashedul, Gilmour Stuart, Haruyama Rei, Budukh Atul, Shankar Abhishek, Mishra Gauravi, Mehrotra Ravi, Matsuda Tomohiro, Inoue Manami, Abe Sarah Krull
Graduate School of Public Health, St. Luke's International University.
Division of Prevention, National Cancer Center Institute for Cancer Control.
J Epidemiol. 2025 Mar 5;35(3):129-140. doi: 10.2188/jea.JE20240065. Epub 2025 Jan 31.
The burden of cancer in India has been rising, yet testing for early detection remains low. This study explored inequalities in the uptake of breast cancer (BC) examination and cervical cancer (CC) among Indian women, focusing on socioeconomic, regional, and educational differences.
Data from the 2019-21 National Family Health Survey (n = 353,518) were used to assess the uptake of BC examination and CC testing. Inequalities were quantified using the slope index of inequality (SII), relative index of inequality (RII), and relative concentration index (RCI). SII measured absolute inequality, while RII and RCI assessed relative inequality between disadvantaged and advantaged groups.
The ever uptake of tests for early detection of BC and CC were low at 9 and 20 per 1,000 women, respectively. Higher uptake was observed among women from the richest households compared to the poorest (SII: 1.1 for BC and 1.8 for CC). The magnitude of relative socioeconomic inequalities was more pronounced in rural areas (RCI: 22.5 for BC and 21.3 for CC) compared to urban areas. Similarly, higher-educated women were 4.84 times (RII: 4.84) and 2.12 times (RII: 2.12) more likely to undergo BC examination and CC testing, respectively, compared to non-educated women. The Northeastern region exhibited greater socioeconomic inequality, while the Western region showed more education-based inequality.
The lower uptake of BC examination and CC testing and the marked inequalities underscore the need for targeted interventions to improve access and utilization of testing services, especially among lower-educated women, and those in rural areas.
印度的癌症负担一直在上升，但早期检测的检测率仍然很低。本研究探讨了印度女性在接受乳腺癌（BC）检查和宫颈癌（CC）检查方面的不平等情况，重点关注社会经济、地区和教育差异。
使用2019 - 21年全国家庭健康调查（n = 353,518）的数据来评估BC检查和CC检测的接受情况。使用不平等斜率指数（SII）、相对不平等指数（RII）和相对集中指数（RCI）对不平等进行量化。SII衡量绝对不平等，而RII和RCI评估弱势群体和优势群体之间的相对不平等。
BC和CC早期检测的检测率一直很低，分别为每1000名女性中有9例和20例。与最贫困家庭的女性相比，最富有家庭的女性检测率更高（SII：BC为1.1，CC为1.8）。与城市地区相比，农村地区相对社会经济不平等的程度更为明显（RCI：BC为22.5，CC为21.3）。同样，与未受过教育的女性相比，受过高等教育的女性接受BC检查和CC检测的可能性分别高4.84倍（RII：4.84）和2.12倍（RII：2.12）。东北地区表现出更大的社会经济不平等，而西部地区则表现出更多基于教育的不平等。
BC检查和CC检测的接受率较低以及明显的不平等突出表明，需要有针对性的干预措施来改善检测服务的可及性和利用率，特别是在受教育程度较低的女性和农村地区的女性中。
