Determinants of breast and cervical cancer screening uptake among women in Zambia: analysis of the 2024 Zambia demographic and health survey

Abstract

Abstract Breast and cervical cancers remain leading causes of cancer-related morbidity and mortality among women globally, particularly in low- and middle-income countries. The World Health Organization (WHO) has prioritised both cancers through the Global Breast Cancer Initiative and the global cervical cancer elimination strategy, which targets 70% screening coverage using high-performance tests among women aged 35 and 45 years. Despite Zambia’s expansion of cervical cancer prevention services, little is known about the population-level uptake of breast and cervical cancer screening and the sociodemographic factors that drive it. This study assessed the determinants of breast and cervical cancer screening uptake among women aged 15–49 years using data from the 2024 Zambia Demographic and Health Survey (ZDHS). We categorised the women into four mutually exclusive groups: no screening, breast-only screening, cervical-only screening, and breast and cervical screening. Survey weights were applied to account for the complex sampling design of the survey. Associations were examined using survey-adjusted multinomial logistic regression. All analyses were conducted using Stata 14.2. Among the 13,876 women included in the analysis, 68.84% reported no cancer screening, 4.67% reported breast-only screening, 17.87% reported cervical-only screening, and 8.63% reported both breast and cervical screening. Screening uptake increased with age but remained below recommended targets even among priority age groups: 43.8% of women aged 35–39 years and 51.3% of women aged 45–49 years reported any cervical cancer screening (cervical-only or combined). In multivariable adjusted analyses, these patterns were largely confirmed. Women aged 45–49 years were significantly more likely to undergo cervical-only screening (RRR 9.64; 95% CI 6.66–13.96) and combined screening (RRR 12.01; 95% CI 7.35–19.63) compared with adolescents aged 15–19 years. For breast-only screening, older age (35–44 years) and higher parity were the principal significant determinants, with women of parity 6 or more nearly twice as likely to report breast-only screening compared with nulliparous women (RRR 2.22; 95% CI 1.25–3.93). Higher education was associated with increased cervical-only (RRR 1.36; 95% CI 1.03–1.79) and combined screening (RRR 1.43; 95% CI 1.03–2.00). In contrast, rural residence was associated with lower cervical-only screening uptake (RRR 0.76; 95% CI 0.63–0.93), and high community poverty was associated with lower cervical-only (RRR 0.44; 95% CI 0.33–0.59) and combined screening (RRR 0.63; 95% CI 0.44–0.92). Breast and cervical cancer screening coverage among women aged 15–49 years in Zambia remains low, with substantial socio-demographic and geographic inequities. Screening uptake was strongly associated with age, parity, educational attainment, contraceptive use, and media exposure, while rural residence and high community poverty were consistent barriers across screening outcomes. Coverage remains markedly below the WHO 70% cervical cancer screening target, and no structured breast cancer early detection programme currently exists to address the growing burden of breast cancer among reproductive-age women in Zambia. Strengthening integrated screening strategies within reproductive health, primary care, and HIV service platforms, alongside targeted community-based outreach and health education, is essential for improving early detection and reducing the burden of women’s cancers in Zambia.