Joint Uptake and Determinants of Breast and Cervical Cancer Screening among Women in Zambia: Analysis of the 2024 Zambia Demographic and Health Survey

Abstract

<title>Abstract</title> Breast and cervical cancers are the most common causes of cancer morbidity and mortality among women in Zambia. Although Zambia has expanded cervical cancer screening through public-sector programs, population-level uptake and joint screening patterns for breast and cervical cancers remain poorly characterised. This study assessed the joint uptake and determinants of breast and cervical cancer screening among women aged 15–49 years in Zambia using 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 complex sampling designs. Associations were examined using survey-adjusted multinomial logistic regression. We used Stata version 14.2 was used for the analysis. Among the 13,876 women, 68.21% reported no cancer screening, 4.52% reported breast-only screening, 18.41% reported cervical-only screening, and 8.85% reported both breast and cervical screening. Screening increased with age but remained below the benchmark, even among priority age groups: 43.8% of women aged 35–39 and 48.3% of women aged 45–49 reported any cervical cancer screening. In adjusted analyses, screening uptake increased strongly with age. Women aged 45–49 years were far more likely to undergo cervical-only (RRR, 9.66; 95% CI 6.67–13.98) and combined screening (RRR, 12.03; 95% CI, 7.36–19.64) than adolescents aged 15–19 years. Higher education was associated with increased cervical-only (RRR, 1.36; 95% CI, 1.03–1.79) and combined screening (RRR, 1.44; 95% CI, 1.03-2.00). In contrast, rural residence (RRR, 0.76; 95% CI, 0.63–0.92) and high community poverty (RRR, 0.45; 95% CI, 0.33–0.60) were associated with lower cervical and combined screening uptake. Media exposure (RRR, 1.27; 95% CI, 1.04–1.56) was independently associated with higher combined screening, whereas healthcare barriers and marital status showed outcome-specific associations (RRR, 0.75; 95% CI, 0.64–0.90 and RRR, 0.80; 95% CI, 0.70–0.92 respectively). Breast and cervical cancer screening coverage among women aged 15–49 in Zambia remains low, with substantial socio-demographic and geographic inequities and marked shortfalls relative to the WHO 70% screening targets.