Prevalence and associated factors of mammography uptake among the women aged 45 years and above: policy implications from the longitudinal ageing study in India wave I survey.

BACKGROUND

Breast cancer emerged as number one cancer among women worldwide in terms of incidence and mortality. Majority of breast cancers diagnosed in India are among women aged 45 years and above. A low proportion of Indian female population in reproductive age group (30-49 years) underwent breast cancer screening. The national operational framework includes mammography as one of the investigation modalities under the algorithm for early detection and management of breast cancer. This study describes prevalence and associated factors of mammography uptake in women aged 45 years and above.

METHODS

We utilized data from 35,083 women aged ≥ 45 years in the Longitudinal Aging Study of India, a nationwide representative survey of the Indian population. The outcome variable was self-reported history of undergoing mammography in past two years before the survey as a representation of early detection of breast cancer. Demographic, behavioural, and clinical characteristics were taken as independent variables. Univariable and multivariable models were applied for the following age groups: 45-59 years and ≥ 60 years, and unadjusted and adjusted odds ratios were calculated.

RESULTS

The prevalence of mammography was 1.3% among Indian women aged 45 years and above, 1.7% among 45-59 years and 0.9% among women ≥ 60 years. The highest prevalence was reported in Kerala and the lowest was in Nagaland. Among women in 45-59 years age group, secondary or higher education, being currently in union, having diabetes, neurological illness, hearing problems, and reproductive health problems, better cognition level, and self-history of cancer were found to be associated with increased mammography uptake. Urban residence, being currently in union, having bone/joint disease, hearing problem, and one or multi-morbidity, better cognition level and self and family history of cancer were associated with higher mammography uptake among elderly women.

CONCLUSIONS

Low rates of mammography among women across the country, along with inter-state disparities, highlight inadequate coverage of early detection of breast cancer under National program. Increasing burden of breast cancer in all states underscores need to implement early detection program proactively. Disparities in mammography uptake by age, residence and co-morbidities reflect the need for special focus and context-specific research for pragmatic interventions.