Background
Breast and cervical cancers are the most common cancers among Nigerian women, causing over 45,000 new cases and 23,000 deaths in 2022. Although both are detectable through screening, fewer than 5% of women have ever been screened for cervical cancer, far below the 2027 target of 50%. National averages mask substantial geographic inequalities, making it crucial to identify areas where high risk coincides with low screening coverage (unmet screening need) to guide targeted prevention efforts.
Objectives
To identify geographic priority areas for breast and cervical cancer prevention in Nigeria by examining spatial patterns of population-level risk, screening uptake, and unmet screening need, and to assess individual- and contextual-level determinants of screening utilisation.
Methods
We analysed data from the 2024 Nigeria Demographic and Health Survey, including 38,994 women aged 15–49 years across 1,380 geocoded clusters in 37 states. Composite risk scores for breast and cervical cancer were derived from socio-demographic, reproductive, behavioural, and health-access variables, reflecting population vulnerability rather than biological risk. Scores were averaged at the cluster level and stabilised using empirical Bayes methods. Screening uptake was defined as self-reported cervical cancer testing or breast examination. Spatial clustering of risk and screening was assessed using standard spatial autocorrelation measures. An unmet screening need index combined cluster-level risk and inverse screening coverage, categorised into low, moderate, and high priority areas. Multilevel logistic regression models with random intercepts for clusters and sub-regions were fitted separately for cervical and breast cancer screening, adjusting for age and accounting for survey design.
Results
Nationally, 3.1% of women (95% CI: 2.9–3.4%) had cervical cancer testing, and 5.5% (95% CI: 5.2–5.9%) had a breast examination. The North-East and North-West had the lowest coverage and the highest clustering of elevated risk scores. Higher composite risk scores were linked to lower screening uptake. For cervical cancer, a one standard deviation increases in risk reduced the odds of screening by 35% (OR 0.65, 95% CI: 0.59–0.71); for breast cancer, the reduction was 42% (OR 0.58, 95% CI: 0.55–0.62). Screening increased with age: women 45–49 had over eight times higher odds for cervical cancer and more than four times higher odds for breast examination compared with women 15–24. Geographic context remained significant after adjustment, with about 20% of the variation in screening attributable to differences between sub-regions and clusters. Unmet screening need was highest in the North-East and North-West, and lowest in the South-South and South-West.
Conclusions and Implications
Breast and cervical cancer screening in Nigeria is lowest where population risk is highest, creating geographic inequities. Integrating spatial analysis with multilevel modelling provides a data-driven framework to identify priority areas, guiding targeted screening, mobile services, community outreach, and subnational cancer control planning to enhance equity and efficiency.

Unmet Cervical Cancer Screening Need by Clusters in Nigeria