Self-referral dominates breast cancer diagnosis in Kazakhstan: organised screening reaches only 16%

Background

Kazakhstan operates a population-based mammography screening programme covering women aged 40-70 since 2018, with coverage reaching 70% by 2024. Yet in Aktobe region, Western Kazakhstan, the dominant diagnostic route remains symptom-driven self-referral rather than organised screening. Understanding how pathways distribute and predict stage at diagnosis is essential for primary care reform.

Methods

Retrospective population-based registry study of all confirmed breast cancer cases (ICD-10: C50) in Aktobe region, 2015-2025 (n = 2,232). Diagnostic pathway was categorised as: organised screening, clinical examination room detection, self-referral, or other circumstances. Multivariable logistic regression estimated adjusted odds ratios (aORs) for early diagnosis (Stage I or IIa) by pathway, controlling for age, residency, nationality, social status, and calendar year. Analyses performed in R 4.5.1.

Results

Self-referral was the most common pathway (46.3%), followed by other circumstances (31.9%), organised screening (16.3%), and clinical examination room detection (5.6%). Self-referral was independently associated with 46% lower odds of early diagnosis (aOR 0.54, 95% CI 0.36-0.81; p = 0.004). Organised screening showed a positive but non-significant association (aOR 1.27, 95% CI 0.81-1.97; p = 0.295). Other circumstances also showed lower odds (aOR 0.62, 95% CI 0.41-0.92; p = 0.020).

Conclusions

Self-referral dominance and marginal screening reach represent a primary care integration failure. Embedding structured clinical breast examination into routine primary care contacts and increasing screening uptake beyond infrastructure expansion are prerequisites for equitable early detection in Kazakhstan.

Key messages

• Organised screening accounted for only 16.3% of breast cancer diagnoses in Aktobe region, while self-referral dominated at 46.3%, indicating failure to translate screening infrastructure to practice.

• Self-referral was independently associated with 46% lower odds of early diagnosis (aOR 0.54, 95% CI 0.36-0.81), confirming symptomatic care cannot substitute population-based detection.