Introduction
Early detection through screening is essential to reduce mortality from breast and cervical cancers in India. A recent scoping review synthesizes evidence across multiple screening programs, revealing persistent low participation despite growing program efforts. This article distills the key findings, barriers, and policy implications to strengthen India’s cancer screening landscape for women.
Overview of the Review
The scoping review screened a large body of literature to map existing breast and cervical cancer screening efforts in India. From 2,688 articles identified in database searches, 144 articles had full texts available for in-depth assessment. Among these, 59 published articles described 57 distinct screening programs or related initiatives. This scale demonstrates substantial interest in screening but also highlights fragmented evidence and uneven implementation across regions.
What the Evidence Shows About Participation
– Low uptake: Across multiple programs, participation rates remain suboptimal, particularly in rural and underserved populations. Even where screening services are available, many eligible women do not participate due to a complex mix of barriers.
– Inconsistent coverage: Programs vary widely in reach, with some reporting pilot success while broader rollouts show limited reach beyond urban centers.
– Age and risk targeting: Breast and cervical cancer screening strategies often rely on age-based criteria that may miss high-risk groups or fail to adapt to local contexts, reducing overall participation.
– Integration gaps: Screening is frequently not embedded within primary care or community health platforms, reducing convenient access and continuity of care.
Barriers to Participation
The scoping review identifies a spectrum of obstacles that hinder risk-appropriate uptake:
– Socioeconomic and educational factors: Low awareness of cancer symptoms and screening importance, coupled with financial and opportunity costs, limits participation.
– Cultural and gender norms: Stigma, modesty concerns, and fear of diagnosis discourage women from seeking screening.
– Health system constraints: Limited trained personnel, insufficient screening sites, long wait times, and stockouts of consumables undermine confidence and utilization.
– Logistical hurdles: Transportation, distance to services, and inconsistent follow-up pathways deter ongoing engagement with screening programs.
– Communication gaps: Inadequate health messaging and culturally tailored outreach reduce relevance and trust in screening services.
What Works: Insights for Improving Participation
– Community-based outreach: Programs leveraging community health workers and local women’s groups show promise in raising awareness, reducing fear, and guiding women through the screening process.
– Mobile and decentralized services: Bringing services closer to communities, especially in rural districts, improves access and timeliness of screening.
– Integrated care pathways: Linking screening with existing maternal and child health visits and primary care visits creates convenient, reinforced touchpoints.
– Education and messaging: Culturally appropriate education campaigns that address myths and stigma can shift attitudes toward screening.
– Data-driven targeting: Local data to identify underserved areas enables tailored outreach, resource allocation, and monitoring of participation trends.
Policy and Practice Implications
To boost participation in breast and cervical cancer screening in India, policymakers and health managers should consider:
– Scaling up community-led strategies alongside facility-based services, ensuring equity of access across rural and urban settings.
– Strengthening the health system: expanding trained personnel, screening capacity, and supply chains; enabling fast referral and follow-up for abnormal results.
– Integrating screening into routine care: Add breast and cervical screening as standard components of primary healthcare visits and national health programs.
– Targeted communication: Develop locally resonant messages, translated into regional languages, that address common barriers and promote screening benefits.
– Monitoring and evaluation: Build robust data collection and reporting systems to assess participation, identify gaps, and adjust strategies in real time.
Conclusion
The scoping review underscores that low participation in breast and cervical cancer screening in India persists despite an expanding program footprint. Addressing multifaceted barriers through community engagement, integrated care, and data-informed policies is essential to improve uptake, equity, and ultimately cancer outcomes for Indian women.
