{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T16:13:05Z","timestamp":1784823185432,"version":"3.55.0"},"reference-count":44,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Breast cancer is the leading oncological diagnosis among women in Kazakhstan, yet a substantial proportion of cases are still detected beyond the earliest stages, particularly in peripheral regions such as Aktobe. Despite a national mammography screening programme covering women aged 40\u201370 years since 2018, structural differences in access to early diagnosis\u2014related to geography, socioeconomic circumstances, and the diagnostic pathway\u2014may compromise outcomes. We aimed to identify factors independently associated with early-stage presentation and to characterise the temporal pattern of early-stage presentation without assuming a monotonic trend. Methods and Materials: We conducted a retrospective, population-based analytical study of all confirmed breast cancer cases (ICD-10 C50) registered in the Aktobe regional cancer registry and diagnosed between 1 January 2015 and 31 December 2025 (n = 2232). The outcome was early-stage presentation, defined literally as Stages I\u2013IIa at diagnosis, with Stages IIb\u2013IV as the comparator; this is a stage-at-presentation classification and is not intended to indicate surgical operability or treatment sequence. Multivariable logistic regression estimated adjusted odds ratios (aORs). Two models were used: Model A included age, sex, residence, administrative nationality, employment\/social status, and calendar year; Model B additionally included the diagnostic pathway, which may lie on the causal pathway between structural determinants and stage. Calendar year was modelled as a categorical variable, and a complementary phase-based model (2015\u20132017, 2018\u20132019, 2020\u20132022, 2023\u20132025) was fitted. A residence-by-year interaction; a multinomial sensitivity analysis separating Stages IIb, III, and IV; discrimination (AUC, Brier score); and calibration (Hosmer\u2013Lemeshow test, calibration plot) were also assessed. Results: Of 2232 patients (99.1% female; mean age 57.0 \u00b1 12.5 years), 1323 (59.3%) presented at Stages I\u2013IIa. In Model A, rural residence (aOR 0.77, 95% CI 0.64\u20130.93; p = 0.006), unemployment relative to employment (aOR 0.69, 95% CI 0.52\u20130.90; p = 0.007), Russian administrative nationality (aOR 0.64, 95% CI 0.50\u20130.82; p &lt; 0.001), and other non-Kazakh nationalities (aOR 0.73, 95% CI 0.58\u20130.94; p = 0.012) were independently associated with lower odds of Stage I\u2013IIa presentation. In Model B, patient-initiated (self-referral) presentation was associated with lower odds relative to clinical examination room detection (aOR 0.46, 95% CI 0.30\u20130.72; p &lt; 0.001), whereas organised screening was not significantly associated (aOR 1.52, 95% CI 0.95\u20132.43; p = 0.082). The calendar-year pattern was clearly non-linear (categorical vs. linear year: likelihood-ratio \u03c72 = 76.1, df = 9, p &lt; 0.001): odds of Stage I\u2013IIa presentation peaked in 2018 (aOR 2.49, 95% CI 1.57\u20133.93 vs. 2015), were lowest in 2022 (aOR 0.64, 95% CI 0.42\u20130.97), and partially recovered thereafter. In the phase-based model (reference 2015\u20132017), the aORs were 1.62 (95% CI 1.22\u20132.15) for 2018\u20132019, 0.54 (95% CI 0.41\u20130.69) for 2020\u20132022, and 0.62 (95% CI 0.46\u20130.84) for 2023\u20132025. Model discrimination was limited (AUC 0.648, 95% CI 0.625\u20130.671; Brier score 0.226) with acceptable calibration (Hosmer\u2013Lemeshow \u03c72 = 8.38, df = 8, p = 0.40). Conclusions: In this registry-based cohort, rural residence, unemployment, non-Kazakh administrative nationality, and patient-initiated presentation were independently associated with lower odds of early-stage breast cancer presentation. The temporal pattern was non-monotonic, with the highest odds around the 2018 screening expansion, a marked reduction during 2020\u20132022, and only partial recovery thereafter. These are observational associations rather than causal or programme-evaluation findings; they should be interpreted as hypothesis-generating and require confirmation with screening-process, service-capacity, and patient-level access data.<\/jats:p>","DOI":"10.3390\/medicina62081431","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T15:05:42Z","timestamp":1784819142000},"page":"1431","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Determinants of Early-Stage Breast Cancer Presentation in Western Kazakhstan: A Population-Based Analysis of Urban\u2013Rural Disparities and Diagnostic Pathways (2015\u20132025)"],"prefix":"10.3390","volume":"62","author":[{"given":"Dinara","family":"Zholmukhamedova","sequence":"first","affiliation":[{"name":"Department of Oncology, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0165-9312","authenticated-orcid":false,"given":"Maiya","family":"Taushanova","sequence":"additional","affiliation":[{"name":"Department of Public Health and Healthcare with a Nursing Course, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8874-2401","authenticated-orcid":false,"given":"Dariusz","family":"Walkowiak","sequence":"additional","affiliation":[{"name":"Department of Organization and Management in Health Care, Poznan University of Medical Sciences, 61-701 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lyudmila","family":"Yermukhanova","sequence":"additional","affiliation":[{"name":"Department of Public Health and Healthcare with a Nursing Course, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Danyarova","sequence":"additional","affiliation":[{"name":"Republic Center of Endocrinology and Diabetes, Joint Stock Company \u201cResearch Institute of Cardiology and Internal Diseases\u201d, Almaty 050000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1796-2604","authenticated-orcid":false,"given":"Indira","family":"Karibayeva","sequence":"additional","affiliation":[{"name":"Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30458, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9724-8720","authenticated-orcid":false,"given":"Aizat","family":"Aimakhanova","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Fundamentals of Scientific Research, Asfendiyarov Kazakh National Medical University, Almaty 050000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aizat","family":"Seidakhmetova","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Nursing, Joint Stock Company \u201cSouth Kazakhstan Medical Academy\u201d, Shymkent 160019, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anara","family":"Tulyayeva","sequence":"additional","affiliation":[{"name":"Department of Oncology, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"ref_1","first-page":"209","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA A Cancer J. 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