Wealth inequalities in uptake of breast and cervical cancer screening services in Kenya: evidence from the 2022 Kenya demographic and health survey

Breast and cervical cancers remain leading causes of cancer morbidity and mortality among women globally, with a disproportionate burden borne by low- and middle-income countries. Early detection through screening is a cornerstone of cancer control; however, access to screening services is often unequally distributed across socioeconomic groups. This study assessed the prevalence of breast and cervical cancer screening among women in Kenya and quantified wealth-related inequalities in screening uptake using nationally representative survey data from the 2022 Kenya Demographic and Health Survey (KDHS). A cross-sectional study design was employed using data from the 2022 KDHS, including 16,716 weighted observations of women aged 15–49 years. Outcome variables were self-reported breast and cervical cancer screening. Socioeconomic inequality was measured using the Concentration Index (CI) and Lorenz-type concentration curves. Decomposition analysis was performed to identify the relative contributions of wealth, education, place of residence, working status, parity, age, and other covariates to observed screening inequalities. Indirect standardisation was applied to adjust for non-economic determinants. Overall, 13.8% (95% CI: 13.1–14.6%) of women had undergone breast cancer screening, and 16.8% (95% CI: 15.9–17.8%) had been screened for cervical cancer. Breast cancer screening was significantly concentrated among wealthier women (CI = 0.241; p < 0.001), as was cervical cancer screening (CI = 0.190; p < 0.001). After indirect standardisation, pro-rich inequality persisted for both breast cancer (CI = 0.049; p < 0.001) and cervical cancer screening (CI = 0.040; p < 0.001), indicating that inequalities are not fully explained by demographic and social factors alone. Urban residence, higher education, employment, older age, and contraceptive use were positively associated with screening uptake. Wealth-related inequalities in both breast and cervical cancer screening are substantial and persist after adjustment for key demographic determinants in Kenya. Incorporating equity-oriented considerations into the planning and scale-up of screening services is urgently needed to expand access among economically disadvantaged women, particularly those residing in rural areas with low educational attainment.