Cervical cancer screening has long been recognized as a vital preventive measure, capable of detecting precancerous changes before they develop into invasive disease. Yet in Ghana, uptake remains critically low among women of reproductive age. Strikingly, pregnant women—a group with frequent healthcare interactions—have received scant attention in previous research, despite their unique access points to antenatal services. The study leveraged Andersen’s Behavioural Model of Health Services Use to dig deeper into the behavioral dimensions shaping health service utilization specifically within this cohort.

Methodologically, the research employed a facility-based cross-sectional design encompassing 456 pregnant women, gathering data through meticulously structured closed-ended questionnaires. This approach provided robust quantitative insights into screening behaviors, knowledge levels, and the socio-cultural influences at play. Advanced statistical tools, including STATA 17 and IBM SPSS AMOS 29, were harnessed to perform sophisticated analyses such as chi-square testing, logistic regression, and confirmatory factor analysis. These methods ensured both the reliability and validity of the findings, capturing the latent constructs influencing health behavior through a structural modeling lens.

Remarkably, the study revealed that 87.3% of participants had never undergone cervical cancer screening—not before pregnancy nor during the current gestation. This high prevalence of non-screening is particularly concerning given antenatal care’s potential as a pivotal intervention point. The majority of women demonstrated only moderate knowledge about cervical cancer and screening procedures, highlighting a significant educational gap. This knowledge deficit likely contributes to low perceived susceptibility and motivation, further exacerbated by socioeconomic and cultural factors.

A constellation of predictors emerged as significant barriers within the Andersen model’s framework. Women lacking formal education were disproportionately less likely to be screened, underscoring the critical role of literacy and health education. Unemployment and rural residency also correlated strongly with non-screening, reflecting socioeconomic and geographic disparities in health access. These predisposing characteristics interact with enabling resources—such as media exposure, which was limited among many—and community-level factors including social stigma and cultural norms that restrict healthcare-seeking behaviors.

Systemic obstacles were no less influential in curbing screening uptake. Perceived high costs of screening, irrespective of actual charges, contributed to reluctance, as did the presence of unfriendly healthcare personnel, which discourages attendance and engagement. Community unawareness of cervical cancer risks further compounds these issues by failing to generate demand for preventive services. The research’s structural model confirmed these multifaceted relationships, achieving an excellent model fit that validates the integrated nature of predisposing, enabling, and systemic factors driving behavior.

Intriguingly, the analysis demonstrated strong correlations among the three domains of Andersen’s Behavioural Model—particularly between enabling and systemic factors—indicating that health service utilization is shaped by a complex interdependence of personal, community, and healthcare system elements. The predisposing construct exerted the most direct influence on the likelihood of non-screening, followed by systemic barriers, emphasizing that internal dispositions and external healthcare environment features are jointly critical in determining health outcomes.

These findings suggest that piecemeal interventions targeting isolated factors are unlikely to substantially improve cervical cancer screening rates in this population. Rather, comprehensive, integrated approaches that address educational deficits, empower women economically and socially, and reform health system interactions are necessary. Strategies must transcend conventional health messaging, embedding culturally sensitive and community-engaged frameworks that dismantle stigmas and misinformation.

Moreover, leveraging antenatal care platforms for cervical cancer screening presents a pragmatic solution, capitalizing on existing healthcare contact points to minimize access barriers. Healthcare providers’ attitudes and training must be a focus, ensuring respectful, supportive interactions when offering screening. Accessible media campaigns can elevate awareness broadly while tailoring messages to rural and less educated demographics to maximize impact.

The implications of this research extend beyond the borders of Ghana, resonating with broader challenges in global health equity. As cervical cancer disproportionately affects women in resource-constrained settings, the insights from Pru East Municipality provide an evidence-based blueprint for optimizing screening programs. Interventions designed with Andersen’s model as a framework promise more holistic and effective pathways to reducing preventable cancer mortality.

Looking forward, policymakers, healthcare planners, and international partners need to prioritize multi-sectoral collaborations that integrate educational, social, and health system reforms. Aligning community engagement with policy commitment will be crucial to dismantling entrenched barriers. Systematic monitoring and evaluation using behavioral models can guide adaptive strategies, ensuring interventions remain responsive to the evolving needs of populations.

In conclusion, the new study not only quantifies the extent of cervical cancer screening gaps among pregnant women in Ghana but also elucidates the underlying behavioral determinants with scientific precision. By capturing the dynamic interplay between individual characteristics, enabling factors, and systemic influences, the research charts a clear course toward transformative action. Embracing integrated, culturally congruent, and multi-dimensional strategies will be pivotal to achieving meaningful increases in cervical cancer screening, ultimately saving lives and reducing health disparities in Ghana and similar contexts globally.

Subject of Research: Predictors of non-screening for cervical cancer among pregnant women in the Pru East Municipality, Ghana, using Andersen’s Behavioural Model of Health Services Use.

Article Title: Predictors of non-screening for cervical cancer in Ghana: an application of Andersen’s behavioural model of health services use among pregnant women in Pru East municipality

Article References:
Bardoe, D. Predictors of non-screening for cervical cancer in Ghana: an application of Andersen’s behavioural model of health services use among pregnant women in Pru East municipality. BMC Cancer 25, 1783 (2025). https://doi.org/10.1186/s12885-025-15147-z

Image Credits: Scienmag.com

DOI: 18 November 2025

Breast cancer holds the unfortunate distinction of being the most frequently diagnosed cancer among women globally, yet the burden of this disease is increasingly felt in sub-Saharan Africa, where healthcare infrastructure often lags behind the escalating needs. The research led by Osborne focuses on Sierra Leone, a country where epidemiological data on cancer have traditionally been sparse or aggregated, obscuring sex-specific prevalence patterns and the extent of inequality. This analysis breaks new ground by utilizing reliable, age-standardized datasets from the World Health Organization to provide a precise and comparative view of breast cancer trends disaggregated by sex.

Between 2000 and 2019, the age-standardized prevalence of breast cancer in Sierra Leone escalated notably from 52.4 to 78.3 cases per 100,000 population. These figures highlight a gradual yet significant upward trajectory in breast cancer diagnoses, underlining growing public health challenges in managing this cancer. Notably, while female breast cancer prevalence showed a marked increase, male breast cancer rates remained persistently low, though not negligible, suggesting divergent epidemiological patterns and potential under-recognition or underreporting in males.

Females in Sierra Leone experienced an alarming rise in breast cancer prevalence—from 102.7 cases per 100,000 in 2000, with confidence intervals indicating robust data reliability, to 157.9 cases per 100,000 in 2019. This sharp increase of over 50% within two decades mandates urgent attention to screening capabilities, diagnostic accuracy, and treatment accessibility. These findings expose critical gaps in healthcare delivery, where delayed diagnosis and limited therapeutic options may exacerbate survival outcomes for many women.

In contrast, males exhibited stable prevalence figures across the years, with rates fluctuating minimally around 0.7 to 0.8 cases per 100,000 population. Although the prevalence in males is comparatively low, the study’s focused approach underscores the importance of not overlooking male breast cancer, which, despite being rare, carries significant clinical and psychosocial impacts. Moreover, the data firm up a foundation for understanding sex disparities in the Sierra Leonean context, which are more pronounced than previously realized.

Quantifying disparities between sexes, the researchers applied several rigorous inequality measures. The absolute difference in breast cancer prevalence between females and males widened from 102.0 per 100,000 in 2000 to 157.1 per 100,000 in 2019. This metric starkly illustrates the gender gap in disease burden and signals how the female population bears a disproportionate health strain, necessitating targeted interventions tailored to women’s unique risk profiles and healthcare needs.

Moreover, the study reported an increase in the prevalence ratio of females to males from 143.5 to 198.1 over the study period. This nearly twofold female predominance cements the understanding that breast cancer remains a predominantly female disease in Sierra Leone but also emphasizes how the relative risk for women is escalating compared to men. This ratio offers actionable insight for healthcare planners aiming to design equitable resource allocation frameworks.

The implications of these findings extend beyond mere epidemiological documentation. They call for urgent reinforcement and expansion of national cancer registries, which are pivotal for accurate surveillance, timely detection, and evidence-based policy formulation. Currently, data limitations and infrastructural weaknesses hinder comprehensive cancer control strategies in Sierra Leone, leaving many patients undiagnosed or inadequately treated.

Additionally, the study highlights the pressing need to improve access to early detection services for breast cancer. Early-stage diagnosis is critical in improving survival rates but remains hampered by infrastructural deficits, socioeconomic barriers, and low public awareness. Expanding screening programs, especially in rural and underserved areas, alongside educational campaigns, could substantially shift disease trajectories toward better outcomes.

The hurdles to equitable healthcare exist at multiple levels, from systemic deficiencies such as scarce oncology specialists and limited diagnostic imaging, to cultural factors that may delay the seeking of care, particularly among women. Addressing these structural barriers must be integral to breast cancer control efforts, ensuring that health systems are responsive, resilient, and accessible regardless of gender or socioeconomic status.

This comprehensive analysis does not only uncover the growing breast cancer burden among women in Sierra Leone but also advocates for an inclusive, gender-sensitive lens in future research and management approaches. Such an approach recognizes that while men are less frequently affected, their experiences and needs warrant recognition in the healthcare ecosystem.

Future investigations should build upon this foundational study by incorporating risk factor analysis, including genetic, environmental, and lifestyle components, to further elucidate drivers behind the observed trends. Investigative efforts into healthcare-seeking behaviors and treatment adherence could also provide valuable data to inform culturally-appropriate interventions.

At an international level, this work adds to the growing body of evidence emphasizing the urgent need to bolster non-communicable disease frameworks within the global health agenda, especially in sub-Saharan Africa. Investments aimed at capacity building, infrastructure development, and collaborative research partnerships will be pivotal in bridging the gaps unveiled by this study.

In summary, the sex-disaggregated analysis of breast cancer prevalence in Sierra Leone from 2000 to 2019 reveals an increasing disease burden predominantly affecting women, with disparities between sexes widening over time. This trend underscores the critical need for enhanced cancer registries, early detection programs, improved treatment access, and removal of systemic barriers to healthcare. The findings serve as a clarion call for policymakers, healthcare providers, and researchers to unite in combating the rising tide of breast cancer through tailored, equitable, and sustainable approaches.

Ensuring that breast cancer control strategies are informed by robust, sex-specific data is paramount to safeguarding the health of populations in Sierra Leone and beyond. As this study poignantly illustrates, the future of cancer care lies in meticulous surveillance, gender-informed policies, and relentless advocacy for health equity.

Subject of Research: Breast cancer prevalence and sex-based disparities in Sierra Leone

Article Title: Sex-disaggregated analysis of breast cancer prevalence in Sierra Leone

Article References:
Osborne, A. Sex-disaggregated analysis of breast cancer prevalence in Sierra Leone.
BMC Cancer 25, 1022 (2025). https://doi.org/10.1186/s12885-025-14403-6

Image Credits: Scienmag.com

DOI: https://doi.org/10.1186/s12885-025-14403-6