{
  "abstract": "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.\n\nMethods: 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.\n\nResults: 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).\n\nConclusions: 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.\n\nKey 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.\n\n• 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.",
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  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "name": "M Taushanova"
    },
    {
      "name": "D Zholmukhamedova"
    },
    {
      "name": "A Tulyayeva"
    },
    {
      "name": "L Yermukhanova"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8a6rvps20dbyn.bib",
  "cited_by": 0,
  "doi": "10.1093/eurpub/ckag169.1129",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13697786/",
  "id": "8a6rvps20dbyn",
  "issns": [
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    "1464-360X"
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  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
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  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
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  "native_subjects": [
    [
      "heading",
      "6. Poster Displays"
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    [
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      "heading",
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      "2730|Global Cancer Incidence and Screening"
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  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13697786/pdf/?tool=EBI",
  "pmcid": "PMC13697786",
  "pmid": null,
  "published": "2026-10-01",
  "publisher": "Oxford University Press",
  "ris": "https://research.draconitic.com/paper/8a6rvps20dbyn.ris",
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    {
      "first_seen": "2026-10-30T12:18:47Z",
      "native_id": "PMC13697786",
      "source": "pmc",
      "url": "https://doi.org/10.1093/eurpub/ckag169.1129"
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    {
      "first_seen": "2026-10-30T12:21:31Z",
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2730|Global Cancer Incidence and Screening",
      "subfield": "oncology"
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  ],
  "title": "Self-referral dominates breast cancer diagnosis in Kazakhstan: organised screening reaches only 16%",
  "title_text": "Self-referral dominates breast cancer diagnosis in Kazakhstan: organised screening reaches only 16%",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:34:46Z",
  "url": "https://research.draconitic.com/paper/8a6rvps20dbyn",
  "venue": "The European Journal of Public Health",
  "versions": []
}