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

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...

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Main Authors: Janny Liao, Ramaele Moshoeshoe, Michelle D. Holmes, S. V. Subramanian, Jan-Walter De Neve
Format: Article
Language:English
Published: Nature Portfolio 2025-04-01
Series:Nature Communications
Online Access:https://doi.org/10.1038/s41467-025-58875-3
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author Janny Liao
Ramaele Moshoeshoe
Michelle D. Holmes
S. V. Subramanian
Jan-Walter De Neve
author_facet Janny Liao
Ramaele Moshoeshoe
Michelle D. Holmes
S. V. Subramanian
Jan-Walter De Neve
author_sort Janny Liao
collection DOAJ
description 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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spelling doaj-art-d8d1cad0d63d44acbdd7acab7d09dfdf2025-08-20T02:17:52ZengNature PortfolioNature Communications2041-17232025-04-011611910.1038/s41467-025-58875-3Effect of girls’ education on cancer awareness and screening in a natural experiment in LesothoJanny Liao0Ramaele Moshoeshoe1Michelle D. Holmes2S. V. Subramanian3Jan-Walter De Neve4Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of HeidelbergDepartment of Economics, National University of LesothoChanning Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical SchoolHarvard Center for Population and Development Studies, Harvard UniversityHeidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of HeidelbergAbstract 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.https://doi.org/10.1038/s41467-025-58875-3
spellingShingle Janny Liao
Ramaele Moshoeshoe
Michelle D. Holmes
S. V. Subramanian
Jan-Walter De Neve
Effect of girls’ education on cancer awareness and screening in a natural experiment in Lesotho
Nature Communications
title Effect of girls’ education on cancer awareness and screening in a natural experiment in Lesotho
title_full Effect of girls’ education on cancer awareness and screening in a natural experiment in Lesotho
title_fullStr Effect of girls’ education on cancer awareness and screening in a natural experiment in Lesotho
title_full_unstemmed Effect of girls’ education on cancer awareness and screening in a natural experiment in Lesotho
title_short Effect of girls’ education on cancer awareness and screening in a natural experiment in Lesotho
title_sort effect of girls education on cancer awareness and screening in a natural experiment in lesotho
url https://doi.org/10.1038/s41467-025-58875-3
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