National Breast Cancer Screening in Bangladesh: Coverage, Inequities, and COVID-19 Disruption, 2019–2025

Abstract

Breast cancer is the leading cancer among women in Bangladesh, yet population-level data on early detection are very limited. We evaluated national clinical breast examination (CBE) coverage, equity gaps, positivity rates, and program disruptions from 2019 to 2025. We conducted a retrospective analysis of routine program data from 1,206 facilities between January 2019 and September 2025. Eligible denominators were derived from UN World Population Prospects 2022 estimates for women aged 30-69 years, with district-level allocation from the Bangladesh Bureau of Statistics 2022 Census. Outcomes included CBE coverage, positivity rates, and reporting completeness, disaggregated by district, division, and settlement type. Interrupted time-series regression assessed changes in screening counts following the March 2020 COVID-19 lockdown. Cancer registry data from the National Institute of Cancer Research and Hospital (NICRH) were used to contextualize diagnostic confirmation and treatment initiation. A total of 3,091,081 women aged 30–69 years were screened. National coverage increased from 0·3% (114,060 of 32,907,395) in 2019 to 2·4% (844,592 of 34,585,364) in 2023, before declining to 0·9% (315,289 of 36,612,684) in January–September 2025. Divisional coverage in 2023 ranged from 1.5% to 3.1%, while district-level coverage in 2023 ranged from 0.8% to 8.8%. Rural coverage consistently exceeded urban coverage, with a 1.7 percentage point gap in 2023. Mean annual positivity rate was 1·0%, with monthly values ranging from 0·4% to 2.5%. Interrupted time-series analysis showed an immediate step increase following the March 2020 COVID-19 lockdown, followed by a sustained negative slope of –4,699 national examinations per month. Registry linkage suggested that more than three-quarters of women had not initiated treatment prior to reaching tertiary care. Despite screening over three million women, national coverage remained below 3%, with substantial inequities and weak treatment linkage. Strengthening primary care screening and registry integration is essential to improve early detection and cancer outcomes.