Digital access, transportation, and women’s empowerment in breast cancer screening uptake among Cambodian women: Analysis of the Cambodia demographic and health survey 2021–2022

Breast cancer incidence is increasing globally, and it is the third leading cause of morbidity and mortality among women in Cambodia. This study explores how access to digital tools, media exposure, transportation, travel time to health facilities, and autonomy in health decisions relate to breast cancer screening among Cambodian women aged 15-49. The study used nationally representative, cross-sectional data from the Cambodia Demographic and Health Survey (CDHS) 2021-2022. After excluding 204 women who were unaware of breast or cervical cancer screening, the final weighted sample comprised 19,292 participants. The outcome was whether a woman had ever received a breast examination from a healthcare provider, encompassing clinical breast examinations (CBEs) and imaging techniques, such as mammograms. Multivariable logistic regression, adjusted for demographic and socioeconomic characteristics, was used. Only 10.9% (95% CI: 9.7%-11.6%) of women had undergone a breast exam. Exposure to multiple forms of media was associated with a higher odds of screening (AOR = 1.47; 95% CI: 1.13-1.91). Phone ownership-both non-smartphone (AOR = 1.35; 95% CI: 1.03-1.78) or smartphone (AOR = 1.37; 95% CI: 1.03-1.82)-was also positively associated. In contrast, longer travel times of over 30 minutes (AOR = 0.55; 95% CI: 0.39-0.78) and a lack of autonomy in healthcare decisions (AOR = 0.70; 95% CI: 0.52-0.94) were associated with reduced screening. Wealthier women had greater odds of being screened (AOR = 1.86; 95% CI: 1.40-2.48). These findings highlight the need for health initiatives that use digital communication to reach and emphasize the importance of improving transportation, and support women's decision-making to increase screening rates in Cambodia.