From awareness to action: A mixed-method community study on uptake of population-based breast cancer screening in an urban slum of Delhi.

Abstract

e13574 Background: Delayed diagnosis contributes to poor breast cancer outcomes in low-resource settings. We evaluated the yield and feasibility of a population-based screening pathway from community to clinic in an underserved area of Delhi, India. We explored factors influencing screening uptake in the community. Methods: A community-based cross-sectional study was conducted among women aged > 30 years in an underserved urban resettlement colony of Delhi (n = 310). Screening protocols for the referral were tailored for the geography, and liaison was done by the team at various levels. ANM were trained for performing CBE and women with abnormal CBE were referred as per protocol. Necessary quantitative analysis and qualitative thematic analysis for screen-positive and refusal participants was done. Results: A total of 310 women were screened; 11.3% were classified as high risk, and abnormal CBE findings were detected in 8.4%. Participants were also taught about the Self-breast examination. A robust screening protocol and referral pathway for the urban slum was detailed. Mammography was completed by 28.6% of those eligible. Among those imaged, 40% had BI-RADS I, 30% BI-RADS II, and 30% had BI-RADS III findings. Qualitative analysis showed that women completing mammography (screen positive participants) demonstrated preventive health orientation and trust in early detection, whereas refusal was characterized by symptom-based and fatalistic health-seeking behaviour. Refusal was not attributed to dissatisfaction with healthcare providers. Conclusions: Community-based breast lump screening using CBE is feasible in urban resettlement settings but is challenged by poor community participation. Screening uptake is influenced primarily by health-seeking behaviour rather than healthcare dissatisfaction. Hence, the policy-level intervention advocacy should focus on knowledge and awareness, along with subsequent consequences, specifically in under-resourced settings.