Healthcare Utilization and Inequalities in Breast Cancer Early Detection Behaviors Among Women in Türkiye: A...

The aim of this study is to determine the extent to which early breast cancer detection behaviors in Türkiye are associated with age, education, income, and chronic disease status, and to evaluate the relationship of healthcare service utilization (contact with family physicians/general practitioners and specialists) with these behaviors.

A cross-sectional secondary data analysis was conducted using nationally representative microdata from the Turkish Statistical Institute's (TUIK) 2022 Turkiye Health Survey. The analysis included 5554 women aged 40-69. Descriptive statistics were calculated using the FERTFACTOR sample weight. Fully adjusted modified Poisson regression models were constructed for recent mammography (within the last 2 years) and monthly breast self-examination (BSE) (adjusted prevalence ratio, aPR), while Classification and Regression Tree (CART) analysis with five-fold cross-validation was applied to identify targetable risk profiles. (The maximum tree depth was set at 3, and the minimum terminal node size at 250 individuals.) Results: The rates of undergoing a recent mammogram and performing monthly BSE were 23.5% and 25.0%, respectively. Both early detection behaviors were more frequent among women who had contact with both a family physician/general practitioner and a specialist physician within the past 12 months. While contact with a specialist physician was independently associated with both behaviors, education level was positively associated with them, whereas the presence of a chronic disease was associated only with having a recent mammogram. In the CART analysis, the initial split occurred based on BSE behavior, and the prevalence of recent mammography varied approximately eightfold across the terminal nodes (cross-validated AUC = 0.681).

In Türkiye, behaviors related to the early detection of breast cancer are associated with age, education, and contact with healthcare services. Fewer than one in four women were up to date with mammography, underscoring a substantial early detection gap. Contact with a specialist physician showed the strongest association; however, given the cross-sectional design, causality cannot be inferred and reverse causation cannot be excluded. Systematizing early detection recommendations within primary care and implementing targeted strategies for low-socioeconomic groups may help increase participation in screening.