Reported clinical breast examination activity in Bangladesh, 2019–2025: Temporal trends, geographic variation, positivity, and reporting completeness
TL;DR
Reports of CBE activity expanded through 2023 but subsequently declined, with marked geographic variation and persistently incomplete reporting, rather than true population screening coverage.
Abstract
Background Routine clinical breast examination (CBE) services contribute to breast cancer early-detection activities in Bangladesh, but national program performance and reporting completeness are poorly characterized. We assessed reported CBE activity, geographic variation, positivity, reporting completeness, and temporal trends from 2019 through 2025. Methods We retrospectively analyzed routine CBE program data from 1,209 location-specific eligible facilities across Bangladesh from January 2019 through December 2025. Because individual-level identifiers were unavailable, records were analyzed as CBE events rather than unique women screened. Reported CBE examination rates used estimated populations of women aged 30–69 years, with district denominators proportionally allocated using census-based population distributions. Reporting completeness was defined as submitted facility-month reports divided by expected reports. Interrupted time-series regression assessed changes associated with March 2020 using calendar-month fixed effects and heteroskedasticity- and autocorrelation-consistent standard errors. Results A total of 3,193,080 reported CBE events were recorded. The reported examination rate increased from 0.3% in 2019 to 2.4% in 2023, then declined to 1.8% in 2024 and 1.1% in 2025. In 2025, division-level rates ranged from 0.7% to 1.7% and district-level rates from 0.2% to 2.8%. Overall positivity was 1.0% (31,624 positive events), reaching 1.6% in 2025. Mean annual reporting completeness rose from 12.1% in 2019 to 42.2% in 2024 and was 39.7% in 2025; no month reached 60% national completeness. Interrupted time-series analysis found no significant immediate level change (14,416 events; 95% CI −7,438–36,269; P = 0.196) or post-intervention slope change (−375 events/month; 95% CI −1,673–923; P = 0.571). Conclusions Reported CBE activity expanded through 2023 but subsequently declined, with marked geographic variation and persistently incomplete reporting. These findings describe reported program activity rather than true population screening coverage. Strengthening routine reporting, individual-level tracking, quality assurance, and referral follow-up is needed for more reliable program evaluation.