Breast Cancer Screening Uptake and Health Belief Model Constructs by Family History Among Women in Northern India.
TL;DR
Interventions should prioritize increasing awareness and accessibility of CBE and mammography, particularly among women without a family history, along with an emphasis on psychosocial determinants of screening behavior.
Abstract
INTRODUCTION Breast cancer is the most common cancer among women in India. However, screening uptake still remains low. A family history of breast cancer may influence screening behavior through increased risk perception. These psychosocial determinants can be explained using the Health Belief Model (HBM), which further influences the decision to undergo cancer screening. This study aimed to compare the uptake of breast cancer screening methods [breast self-examination (BSE), clinical breast examination (CBE), and mammography] among women with and without a family history of breast cancer. Additionally, sociodemographic and HBM-related correlates of screening uptake were also assessed.
Methods
A cross-sectional study was conducted in Northern India among 224 women aged ≥30 years, including 112 women with a household family history of breast cancer (FH+) and 112 without (FH-). Data were collected using a pre-tested questionnaire covering sociodemographic details, screening practices, and HBM constructs. Screening uptake between groups was compared using the chi-square test. Univariate log-binomial regression was performed to estimate prevalence ratios (PRs) with 95% confidence intervals (CIs) for factors associated with screening uptake.
Results
Women in the FH+ group had significantly higher uptake of CBE (33.0% vs. 17.9%; p = 0.009) and mammography (25.0% vs. 14.3%; p = 0.044) compared to the FH- group, while BSE uptake did not show any significant difference. Regression analysis supported these findings, with a higher uptake of CBE (PR = 1.9; 95% CI: 1.2-3.0) and mammography (PR = 1.8; 95% CI: 1.0-3.1), but not BSE. Age >50 years and employment were associated with higher CBE uptake, while postgraduate education and urban residence were associated with BSE uptake. Women with a family history reported higher mean scores for perceived susceptibility, severity, benefits, and self-efficacy.
Conclusions
Breast cancer screening uptake remains suboptimal in this population. Family history appears to influence provider-based screening more than self-examination practices. Interventions should prioritize increasing awareness and accessibility of CBE and mammography, particularly among women without a family history, along with an emphasis on psychosocial determinants of screening behavior.