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. 2025 Apr 20;16(1):3737.
doi: 10.1038/s41467-025-58875-3.

Effect of girls' education on cancer awareness and screening in a natural experiment in Lesotho

Janny Liao  1   2 , Ramaele Moshoeshoe  3   4 , Michelle D Holmes  5   6 , S V Subramanian  7   8 , Jan-Walter De Neve  9   10
Affiliations

Effect of girls' education on cancer awareness and screening in a natural experiment in Lesotho

Janny Liao et al. Nat Commun. .

Abstract

Breast and cervical cancers are important causes of disability and premature death among women in Sub-Saharan Africa. Previous research has linked girls' education to cancer service access. Here, we examine the causal effect of girls' educational attainment on cancer screening practices by means of a natural experiment in Lesotho. In particular, we exploit variation in educational attainment among women that was introduced by an educational policy (a school-entry age cut-off). Data on awareness towards breast cancer, knowledge of Pap smear, breast self-exam, breast clinical exam, and having received a Pap smear is extracted from the Lesotho Demographic and Health Surveys 2009-10 and 2014 (N = 7971). Each additional year of schooling caused by the education policy increases awareness of breast cancer by 4.7 percentage points (p = 0.014, 95% Confidence Interval [CI]: 1.0, 8.5), awareness of Pap smear by 5.9 percentage points (p = 0.001, 95% CI: 2.3, 9.5), and engagement in Pap smear by 3.5 percentage points (p = 0.004, 95% CI: 1.1, 5.8). We found no statistically significant effects on breast self-exam and breast clinical exam.

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Conflict of interest statement

Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Cancer awareness and screening by educational attainment in Lesotho.
Figure shows breast and cervical cancer awareness and screening by different educational attainment levels among women aged 25–49 years in Lesotho. Data were presented as the probability of each outcome and its 95% confidence intervals. Figure a shows the probability of having performed a breast self-exam (past 12 months), figure b shows the probability of having performed a breast clinical exam (past 12 months), figure c shows the probability of ever having heard of Pap smear, and figure d shows the probability of ever having received a Pap smear (past 12 months in the DHS 2009–10 and lifetime prevalence in the DHS 2014). Unweighted. Source: data from Lesotho DHS 2009–10 and 2014. N = 7971.
Fig. 2
Fig. 2. Educational attainment by month of birth among women in Lesotho.
Figure shows years of total education against the month of birth among women aged 25–49 years. Data were presented as the mean of total years of schooling completed and its 95% confidence intervals. The dashed vertical line represents the school-entry age cut-off for primary school on June 30 in Lesotho. Unweighted. Source: data from Lesotho DHS 2009–10 and 2014. N = 7971.
See this image and copyright information in PMC

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