Overview
In India, participation in breast and cervical cancer screening remains suboptimal, despite national efforts to expand access. A recent scoping review synthesized data from hundreds of studies to map the characteristics of screening programs, the populations they serve, and the barriers that limit participation. This article distills key findings, implications for program design, and actionable recommendations to improve uptake and equity across diverse Indian settings.
Scope and methods
The review screened 2,688 articles, with full text available for 144 studies. Among these, 59 published articles described 57 distinct screening programs, offering a broad view of strategies for breast and cervical cancer screening across urban and rural India, public and private sectors, and various state contexts. The emphasis on both breast and cervical cancer reflects the cancers’ substantial burden and the potential for early detection to save lives.
Current landscape of screening programs
Breast and cervical cancer screening in India is delivered through a mix of opportunistic, population-based, and outreach-driven approaches. Programs frequently leverage existing primary health care networks, community health workers, and mobile clinics to extend reach. Common modalities include clinical breast examination (CBE), mammography in some urban and pilot sites, Pap smear testing, and increasingly HPV-based screening in select programs. The evaluation of these approaches reveals significant heterogeneity in implementation, coverage, and adherence, underscoring the need for context-specific solutions.
Strengths observed
- Integration with primary care can broaden access, especially in rural areas where specialist services are scarce.
- Community health workers and local partnerships help address cultural and logistical barriers, such as stigma and distance to care.
- Task-shifting and simplified screening algorithms facilitate faster service delivery and higher throughput in busy facilities.
Common barriers to participation
- Low awareness and knowledge gaps about cancer risk, screening purpose, and the benefits of early detection.
- Cultural beliefs and fear surrounding cancer, which deter women from seeking screening or follow-up care.
- Financial and logistical obstacles, including transportation costs, time off work, and loss of daily wages.
- Health system bottlenecks such as limited trained staff, inconsistent supply chains for test kits, and fragmented referral pathways.
- Variations in program quality, data collection, and follow-up rates that hinder performance tracking and improvement.
Implications for policy and program design
To raise participation in breast and cervical cancer screening, programs should prioritize culturally sensitive outreach, reliable service delivery, and strong linkages to treatment. Key policy actions include:
- Strengthening community engagement to boost awareness, destigmatize screening, and clearly communicate the benefits of early detection.
- Ensuring sustainable funding for screening initiatives, affordable or free services, and protections for women in informal work sectors who may bear opportunity costs.
- Expanding access through mobile clinics, gender-sensitive staffing, and privacy-respecting environments that build trust among participants.
- Improving data systems for monitoring coverage, follow-up rates, and low-participation hotspots to guide targeted interventions.
Strategies for improving participation
Effective engagement often combines education with practical supports. Examples include reminder systems, transportation assistance, flexible screening hours, and community-based screening events. Programs can also adopt evidence-informed screening schedules, prioritize high-risk populations, and leverage HPV-based approaches where feasible to improve sensitivity and follow-up rates.
Concluding thoughts
The scoping review highlights a persistent gap between screening availability and population participation in India. By integrating community-driven outreach with robust health system supports, there is a clear path toward higher uptake, earlier detection, and improved outcomes for breast and cervical cancer across diverse Indian populations.
