Determinants of Breast Cancer Screening Among Women of Reproductive Age in Sub-Saharan Africa: A Multilevel Analysis

Background: Breast cancer is a significant global health issue, responsible for a large number of female cancer deaths. Early detection through breast cancer screening is crucial in reducing mortality rates. However, regions such as Sub-Saharan Africa (SSA) face challenges in identifying breast cancer early, resulting in higher mortality rates and a lower quality of life. Yet, there is a noticeable gap in the literature concerning breast cancer screening. Thus, this study aimed to estimate the pooled prevalence of breast cancer screening and associated factors among women of reproductive age in SSA.

Methods: A weighted sample of 80,058 reproductive-age women from recent Demographic and Health Surveys in SSA countries was considered for analysis. A multilevel modified Poisson regression model with robust variance was fitted to identify factors associated with breast cancer screening. Four nested models were fitted, and the model with the lowest deviance value was selected. An adjusted prevalence ratio with the corresponding 95% confidence interval was used to measure the strength of the association. Finally, statistical significance was declared at a p-value < 0.05.

Result: The pooled prevalence of breast cancer screening among reproductive-age women in SSA was 11.35% (95% CI: 11.14%, 11.56%), with variations ranging from 4.95% (95% CI: 4.61%, 5.30%) in Tanzania to 24.70% (95% CI: 24.06%, 25.33%) in Burkina Faso. Age (20-24, 25-29, 30-34, 35-39, 40-44, and 45-49 years), secondary and higher education, wealth index, media exposure, parity, contraceptive use, pregnancy status, breastfeeding status, and visiting a healthcare facility in the last 12 months were identified as significant positive determinants of breast cancer screening. Conversely, being a rural resident and having a primary education level were found to be negative determinants.

Conclusion: This study uncovers a low prevalence of breast cancer screening in SSA countries, despite high associated mortality rates. Emphasizing the significance of targeted interventions, it highlights the crucial need to promote education and awareness regarding the benefits of breast cancer screening, particularly in light of the challenges faced by many women in the region.