Determinants of cancer screening awareness and participation among Indonesian women

Background: Cancer screening awareness may vary in low- and middle-income countries lacking established national screening programmes. Additionally, breast self-examination (BSE) to screen breast cancer is common in these countries despite evidence suggesting its lack of benefit. We evaluated co-morbidities as a potential determinant of awareness to breast and cervical cancer screening and BSE practice in older women in Indonesia.

Methods: From the fifth Indonesian Family Life Survey (2014-2015), 5,397 women aged 40 and older without any history of cancer who responded to questionnaires on pap smear, mammography, and BSE were included. Multilevel regression analysis was used to assess potential determinants in relation to awareness to pap smear and mammography, and participation to pap smear and BSE practice. Multivariable analyses were performed to identify independent predictors of cancer screening and participation.

Results: Only 22% women were aware of pap smears, and 32% among them had undergone at least one pap smear in their lifetime. Six percent of participants were aware of mammography, among which 4% had mammogram in the previous year. Twelve percent of women reported they performed BSE at least once a year. Among potential determinants, higher education and household expenditure were consistently associated to higher odds of awareness to pap smear and mammography, participation to pap smear and BSE. We also identified enabling factors linked with cancer screening awareness and participation, including health insurance, distance to health services, and social participation.

Conclusion: Socio-economic determinants were strongly associated with cancer screening awareness and participation among Indonesian women. Our findings may be useful to inform targeted health promotion and screening for cancer in presence of limited infrastructure.