Explaining socioeconomic inequalities in cervical and breast cancer screening among women in Ghana using decomposition analysis

Cervical and breast cancers are the most common cancers among women in Ghana. Breast cancer accounts for the highest number of cancer-related deaths, while cervical cancer ranks second. Screening uptake remains low, partly due to the absence of national screening programs. This study is the first to examine socioeconomic inequalities in cervical and breast cancer screening uptake in Ghana, applying the Wagstaff approach. It further decomposed these indices and determined the contribution of individual factors to observed inequalities. We analyzed data from 14,972 women aged 15–49 years using the 2022 Ghana Demographic and Health Survey. Cervical and breast cancer screening were each measured as a self-reported binary outcome. Cervical cancer screening was defined as an affirmative response to: “Have you ever been tested for cervical cancer by a healthcare provider?” Breast cancer screening was defined as an affirmative response to: “Has a doctor or other healthcare provider examined your breasts to check for breast cancer?” To assess socioeconomic inequalities in cervical and breast cancer screening, we used concentration curves and the Erreygers-corrected concentration index (ECCI), with the household wealth index as a proxy measure for socioeconomic status. We conducted decomposition analysis to identify key drivers of inequalities using the Wagstaff approach. Survey weights were applied in all analyses. Overall, 4.96% and 18.41% of the 14,972 women had undergone cervical and breast cancer screening, respectively. Both concentration curves lay below the line of equality, and positive ECIs, indicating pro-rich inequalities in screening uptake. The overall ECIs were 0.068 (95% CI 0.06–0.08) for cervical cancer screening and 0.210 (95% CI 0.20–0.22) for breast cancer screening. Cervical cancer screening inequality was lower in rural areas (ECI = 0.037; 95% CI 0.03–0.05) than in urban areas (ECI = 0.067; 95% CI 0.05–0.08). The rural-urban gap was wider for breast cancer screening: rural (ECI = 0.121; 95% CI 0.10–0.14) versus urban (ECI = 0.202; 95% CI 0.18–0.22). Regionally, cervical cancer screening inequality was highest in Northern Ghana (ECI = 0.069; 95% CI 0.05–0.08) and similar across the Middle Belt and Southern Ghana. Breast cancer screening inequality was lower in Northern Ghana (ECI = 0.187; 95% CI 0.16–0.21) than in Middle and Southern Ghana (ECI = 0.207; 95% CI 0.18–0.23). Decomposition analysis showed that education was the largest contributor to pro-rich inequality, accounting for 54.6% of cervical and 44.5% of breast cancer screening disparities, followed by wealth status, which explained 37.9% and 36.3% of inequalities, respectively. Urban residence, media exposure, and health insurance coverage also contributed to pro-rich inequalities in both screening outcomes. There is a critical need to address the healthcare needs of poorer women to reduce inequalities in cancer screening in Ghana. Policymakers should expand insurance coverage, increase access to quality education, improve media access, promote women’s economic empowerment to address socioeconomic barriers to cancer screening, and integrate cervical and breast cancer screening into all primary healthcare facilities to improve equitable access. Despite these important findings, the cross-sectional study design limits causal inference, and the findings should be interpreted as associative rather than causal.