Geographic Variation and Factors Associated with Breast Cancer Screening in India Using a Spatial Durbin Approach

Breast cancer is the predominant malignancy in women. Detection of precancerous lesions through screening will help reduce the incidence of breast cancer. Spatial methods help us detect the clusters and present evidence on the related factors considering spatial dependence in the data. The main aim of this study is to identify the social determinants of screening for breast cancer through spatial analysis to support the implementation of cost-effective need-based strategies. Data were obtained from the National Family Health Survey-4 conducted in India during 2015–2016. The present study is focused on breast cancer screening across different districts in India. Spatial clusters and regression models aided in investigating the modifiable factors associated with breast cancer screening. ArcGIS and R software were used for analysis. The moderate spatial autocorrelation in the outcome variable (Moran’s I = 0.57) enforces control for the spatial dependence while analyzing the screening data. The alarming percentage of women getting breast screened for cancer ranged between 0.3 and 57.4. Wealth index, access to a health care facility, and women with mobile phone are observed to be associated with breast cancer screening. Locations with a high percentage of women who belong to the wealth index-poor, a high percentage of women who find reaching the nearest health facility a big problem, and a high percentage of women who do not have a mobile phone are likely to have a very low breast cancer screening. Central, East, and North-East India districts are highly vulnerable to low breast cancer screening.