The dynamics of breast cancer screening approaches in urban India: An ethnographic study from Delhi

As low-and middle-income countries (LMIC) progress through a demographic and epidemiological transition, countries like India are experiencing an increase in the incidence of cancer. For women, much of the cancer-related mortality is due to breast and cervical cancer. Mobile screening camps are being implemented as one of the approaches to expand access to opportunistic cancer screening.Using a socio-ecological framework, we intended to understand how female participants access and navigate the camps and the ways in which breast cancer awareness is affected by this screening process. We conducted 48 in-depth interviews with female camp attendees and stakeholder consultations with doctors and mobile camp staff in the National Capital Region to characterize the different levels of influence that determine whether or not a woman will attend a camp and subsequently seek follow-up. Using the extended case-study method, we examined how the barriers and facilitators of cancer screening vary among different identities and the role of facilitators in mobilization.We found that the influence of social networks and the facilitation of camp organizers are some of the greatest predictors of attendance. We identified specific influencers, such as religious leaders and employers, who have various degrees of engagement with the targeted population and can motivate them to attend the screening camps. We propose a screening programme that would leverage these networks as well as existing programmes, such as the Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH ​+ ​A) platform, for targeted screening and establishing continuity. While capacity is built to host large-scale screening, interim solutions can focus on improving the functioning of existing opportunistic screening by engaging a strong network of community facilitators and closing knowledge gaps. Reducing the cancer burden will require that women are not only screened for cancer, but also able to successfully complete cancer treatment.