Background
Cervical cancer (CC) and breast cancer (BC) account for a substantial proportion of cancer burden among Nigerian women, and delayed presentation continues to compromise survival. Although evidence-based screening methods exist, uptake remains low. In the Federal Capital Territory (FCT), women’s engagement with CC and BC screening is shaped by complex interactions between individual knowledge and attitudes, socio-cultural norms, and health system organization. Understanding these determinants and diagnostic pathways is essential for designing appropriate interventions.

Objectives
The study assessed CC and BC screening uptake among women in FCT and examined individual, social, and health system determinants influencing screening behaviours and pathways to early diagnosis.

Methods
A convergent parallel mixed-methods design was used to examine determinants of CC and BC screening uptake. Quantitative data were collected through a cross-sectional survey of 333 consenting women from October to December 2024 in Dagiri and Gwagwalada communities, assessing screening uptake, socio-demographics, knowledge, attitudes, and access factors. Data were analyzed using descriptive statistics, bivariate tests, and multivariate logistic regression. Qualitative data were generated through four focus group discussions and 25 key informant interviews from July to September 2024, exploring perceptions, beliefs, and experiences. Ethnographic observations in communities and primary health care centres documented health education, service availability, provider attitudes, and contextual influences. Findings were triangulated to strengthen interpretation.

Results
CC screening uptake was extremely low, with only 3.3% of women reporting ever being screened. Knowledge emerged as a critical determinant: women with good knowledge of CC and screening were substantially more likely to have screened compared with those with poor knowledge (13.2% vs 0.4%, p<0.001). This aligned with qualitative findings, which showed that cervical cancer screening was rare, poorly understood, and largely opportunistic, typically occurring following hospital referrals rather than through routine preventive care.  Ethnographic observations further revealed limited visibility and availability of cervical cancer screening services in PHCs, a predominant focus on maternal and child health services, and persistent misconceptions such as beliefs linking cancer to curses or contaminated food that contributed to delayed care-seeking and weak diagnostic pathways.
In contrast, BC screening uptake was considerably higher, with approximately 60% of women reporting prior screening. Higher education was strongly associated with screening uptake, with women who had a tertiary education being significantly more likely to have screened (AOR=4.62, CI:1.54–13.82). Qualitative and ethnographic findings elucidated further that BC screening often occurred through community-based outreach activities, including church- and school-led programs, rather than through routine PHC services. However, many women equated screening with informal breast examinations or lump checks, highlighting gaps in understanding of comprehensive screening and diagnostic processes.
 
Conclusions/Implications
Uptake of CC and BC screening among women in FCT is shaped by interconnected individual, socio-cultural, and health system determinants influencing diagnosis pathways. While community outreach has supported BC screening, CC screening remains critically underutilized due to low awareness, stigma, and inadequate integration into primary healthcare. Interventions that strengthen cancer literacy, address misconceptions, expand community engagement, and integrate screening into routine PHC services are essential to improving timely diagnosis and equitable cancer prevention in Nigeria.