Cancer screening uptake and tobacco-alcohol use among women in Uttarakhand: A district-wise analysis from the 5th National Family Health Survey (NFHS-5).

Background and objectives Screening for cervical, breast, and oral cancer reduces morbidity and mortality, yet uptake in India remains low, particularly in hilly States such as Uttarakhand. This study assesses district-level screening patterns among women in Uttarakhand using National Family Health Survey (NFHS-5) data. Methods District-wise self-reported screening among women aged 30-49 years was analysed and categorised as absent (0.0%), moderate (0.1-0.4%), or high (≥0.5%). District-level tobacco and alcohol use among women aged ≥15 years and literacy were also reviewed. Results Screening uptake ranged from absent to moderate across districts. Haridwar (0.90%) and Champawat (0.57%) reported the highest coverage, while several hilly and urban districts, including Tehri Garhwal, Rudraprayag, Pauri Garhwal, Dehradun, and Nainital, reported no uptake. Tobacco use was highest in Bageshwar (7.7%) and Pauri Garhwal (6.4%), whereas alcohol consumption remained low (0.1-0.7%). A moderate negative correlation was observed between literacy and screening- Haridwar showed the uptake despite lower literacy, while more literate districts like Chamoli and Pithoragarh reported lower participation. Interpretations and conclusions Cancer screening uptake among women in Uttarakhand remains low and uneven. Literacy did not ensure greater participation, underscoring the need for stronger outreach, primary care integration, mobile screening in hilly areas, and community mobilisation.