Understanding Inequalities in Breast and Cervical Cancer Care Pathways in Machakos County, Kenya. A Mixed Methods Study

Introduction and Objectives Breast and cervical cancers remain major causes of morbidity and mortality among women in sub-Saharan Africa. Despite expanding cancer services in Kenya, many women continue to experience delays in diagnosis and treatment. However, little is known about how these delays vary across populations and geographic settings, and where inequalities arise along the cancer care pathway. This study aims to examine inequalities in breast and cervical cancer care pathways in Machakos County, Kenya, and identify opportunities to strengthen equitable cancer care. Methodology The study combines quantitative analyses of routinely collected clinical and registry data with qualitative interviews to investigate inequalities across the cancer care pathway and the patient, provider, and health system factors that contribute to them. Quantitative analyses will examine patterns in cancer diagnosis, referral, treatment initiation, and outcomes to identify variations in access to and delivery of care. Qualitative interviews will explore patient experiences, barriers and facilitators to care, and health system factors contributing to delays across the care continuum. Findings from both components will be integrated to identify priority areas for improving equitable access to timely cancer diagnosis and treatment. Results and Discussion The study is ongoing, with protocol development, stakeholder engagement, and a scoping review to map existing evidence on breast and cervical cancer care pathways across sub-Saharan Africa underway. Data sources have been established through collaboration with county health services and oncology providers. By integrating epidemiological analyses with patient and provider perspectives, the project is expected to generate comprehensive evidence on where and why inequalities arise along cancer care pathways. The findings will contribute to understanding how health system, geographic, and socioeconomic factors influence access to quality cancer care in a low-resource setting and identify opportunities for strengthening patient-centred cancer services. Conclusions This research seeks to provide actionable evidence to support equitable cancer care in Kenya and similar low- and middle-income settings. By identifying critical gaps in cancer care pathways and highlighting opportunities for health system improvement, the study aims to inform policy, service delivery, and future implementation strategies that reduce inequalities and improve outcomes for women affected by breast and cervical cancer. The findings may also provide insights for strengthening equitable cancer care pathways in other low- and middle-income settings facing similar health system challenges.