What is it about?
Breast cancer is becoming more common in LMICs (low- and middle-income countries) like Nepal, but many women do not take part in screening that could detect it early. This study looked at 500 women in Kathmandu Valley to understand how many women actually practice breast cancer screening and what influences their intention to do so. We examined three types of screening: mammography, clinical breast examination, and breast self-examination. We also explored psychological and social factors such as women’s attitudes, family influence, perceived risk, and beliefs about cancer. We found that very few women regularly practiced screening. Only 3.4% had mammograms, 7.2% had clinical exams, and 14.4% performed monthly self-exams . Women were more likely to intend to get screened if they had positive attitudes, support from family or friends, and felt confident in their ability to access screening. Women who believed they were at risk of breast cancer were also more likely to intend to get screened. However, fatalistic beliefs, such as thinking cancer outcomes are beyond control, reduced intention for some types of screening. Overall, this study highlights that both personal beliefs and social influences play a major role in whether women plan to get screened for breast cancer.
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Why is it important?
Breast cancer is often diagnosed late in low-resource settings, leading to worse outcomes and higher costs. This study goes beyond common explanations like lack of access and shows that psychological and social factors strongly shape screening intentions. By applying the theory of planned behavior along with culturally relevant factors like fatalism, this research provides a more comprehensive understanding of why screening uptake remains low. The findings suggest that simply increasing awareness is not enough. Interventions must also involve families, address cultural beliefs, and improve women’s confidence and ability to access screening. These insights can help design more effective, culturally sensitive public health strategies in Nepal and other similar settings, ultimately supporting earlier detection and reducing breast cancer burden.
Perspectives
Working on this study made me realize that access alone does not explain low screening uptake. Even in urban areas where services exist, many women still do not intend to get screened. What stood out most to me was the strong role of family influence and beliefs. In many cases, women’s decisions are not made individually but are shaped by social expectations and support systems. This means that public health interventions need to move beyond individual-focused messaging and engage families and communities. I also found the role of fatalism particularly important. If someone believes that cancer is predetermined or unavoidable, they are less likely to seek preventive care. Addressing these beliefs respectfully and contextually is essential. This work reinforced my interest in designing interventions that are not only evidence-based but also culturally grounded and socially aware.
Divya Bhandari
Harvard University
Read the Original
This page is a summary of: Factors associated with breast cancer screening intention in Kathmandu Valley, Nepal, PLOS One, January 2021, PLOS,
DOI: 10.1371/journal.pone.0245856.
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