1
|
Clarke G, Hyland P, Comiskey C. Women over 50 who use alcohol and their engagement with primary and preventative health services: a narrative review using a systematic approach. J Addict Dis 2024; 42:238-252. [PMID: 37161667 DOI: 10.1080/10550887.2023.2190869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Women who are over 50 years are drinking alcohol in higher quantities and more frequently than in previous decades. Good engagement with primary care is crucial for women's physical and psychological health, particularly if they use alcohol. However, there is little known about the alcohol use of women over 50 and their use of primary care. METHODS A systematic search was conducted on six databases; CINAHL, Medline, PsycINFO, Academic Search Complete, EMBASE and Web of Science to identify literature on primary health care engagement of women 50 years and older (50+) who use alcohol. Titles and abstracts were reviewed and full texts were independently reviewed by two researchers. A narrative review, critical appraisal and synthesis of the eligible studies produced common themes and key findings. RESULTS After excluding 3822 articles, 13 articles were deemed eligible for the review. For this age group (50+), findings were: 1) women who drink heavily were less likely than men to attend General Practitioners (GPs), moderate drinkers were more likely than abstainers to attend mammogram screening, 2) GPs were less likely to ask questions or discuss alcohol with women than with men, 3) GPs offered less advice on alcohol to women than to men, and 4) less women than men received alcohol screening from their GP. DISCUSSION While women 50+ are drinking more, their alcohol use is underreported and insufficiently provided for in primary health. As women's life expectancy increases, improved GP engagement will benefit women's health and reduce future healthcare costs.
Collapse
Affiliation(s)
- Grainne Clarke
- School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland
| | | | - Catherine Comiskey
- School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland
| |
Collapse
|
2
|
Le Bihan-Benjamin C, Audiger C, Khati I, de Bels F, Jean Bousquet P, Barré S. Cervical cancer screening pathways in France in 2015-2021, a nationwide study based on medico-administrative data. Prev Med Rep 2023; 36:102429. [PMID: 37810269 PMCID: PMC10550584 DOI: 10.1016/j.pmedr.2023.102429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023] Open
Abstract
To better document cervical cancer screening (CCS) pathways, the purpose of our study was to examine CCS pathways among women who had undergone a screening test (opportunistic or organised programme), based on real-life data over a 7-year period. This study used data from the French national health care database (SNDS), which covers almost 100 % of the French population of around 66 million inhabitants. Data from 2015 to 2021 were extracted. More than one quarter (27 %) of women who were at least 25 years old in 2015 and up to 65 years old in 2021 were not screened over the 2015-2021 period. Compared to women who had undergone screening at least once, women who were not screened were older (36 % vs. 23 % in the 50-59 years age group in 2015) and lived in the most deprived urban areas (21 % vs 16 % for less and most deprived respectively). 57 % of women underwent screening within recommended intervals, 13 % of women were under-screened, and 30 % were overscreened. Overall, our study identified that, in 2021, women who participated in the French organised screening programme were less likely to be screened within the recommended interval over the 7-year period. These analyses need to be continued over time in order to assess whether the programme helps reintegrate women into the screening process.
Collapse
Affiliation(s)
- Christine Le Bihan-Benjamin
- Health Survey Data Science and Assessment Division, National Cancer Institute, 52 avenue André Morizet 92100 Boulogne-Billancourt, France
| | - Céline Audiger
- Prevention Department, National Cancer Institute, 52 avenue André Morizet 92100 Boulogne-Billancourt, France
| | - Inès Khati
- Health Survey Data Science and Assessment Division, National Cancer Institute, 52 avenue André Morizet 92100 Boulogne-Billancourt, France
| | - Frédéric de Bels
- Prevention Department, National Cancer Institute, 52 avenue André Morizet 92100 Boulogne-Billancourt, France
| | - Philippe Jean Bousquet
- Health Survey Data Science and Assessment Division, National Cancer Institute, 52 avenue André Morizet 92100 Boulogne-Billancourt, France
| | - Stéphanie Barré
- Prevention Department, National Cancer Institute, 52 avenue André Morizet 92100 Boulogne-Billancourt, France
| |
Collapse
|
3
|
Rollet Q, Exarchakou A, Launoy G, Merville O, Rubio FJ, Belot A. Functional forms of socio-territorial inequities in breast cancer screening - A French cross-sectional study using hierarchical generalised additive models. Prev Med 2023; 173:107587. [PMID: 37355102 DOI: 10.1016/j.ypmed.2023.107587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 06/26/2023]
Abstract
To reduce the breast cancer burden, the French National Organised Breast Cancer Screening Programme (FNOBCSP) was implemented in 2004. The recommended participation rate has never been achieved and socio-territorial inequities in participation have been reported on several occasions. We investigated the functional forms and consistency of the relationships between neighbourhood deprivation, travel time to the nearest accredited radiology centre and screening uptake. We used two-level hierarchical generalised additive models in 8 types of territories classified by socio-demographic and economic factors. The first level was 368,201 women aged 50-72 invited to the 2013-2014 screening campaign in metropolitan France. They were nested in 41 départements, the level of organisation of the FNOBCSP. The effect of travel time showed two main patterns: it was either linear (with participation decreasing as travel time increased) or participation first increased with increasing travel time to a peak around 5-15 min and decreased afterward. In nearly all types and départements, the probability of participation decreased linearly with increasing deprivation. Territorial inequities in participation were more context-dependent and complex than social inequities. Inequities in participation represent a loss of opportunity for individuals who already have the worst cancer outcomes. Evidence-based public health policies are needed to increase the effectiveness and equity of breast cancer screening.
Collapse
Affiliation(s)
- Quentin Rollet
- Inequalities in Cancer Outcomes Network (ICON), Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; U1086 "ANTICIPE" INSERM, University of Caen Normandie, Centre François Baclesse, 3, Avenue du Général Harris, Caen 14000, France.
| | - Aimilia Exarchakou
- Inequalities in Cancer Outcomes Network (ICON), Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Guy Launoy
- U1086 "ANTICIPE" INSERM, University of Caen Normandie, Centre François Baclesse, 3, Avenue du Général Harris, Caen 14000, France
| | - Ophélie Merville
- U1086 "ANTICIPE" INSERM, University of Caen Normandie, Centre François Baclesse, 3, Avenue du Général Harris, Caen 14000, France
| | - Francisco J Rubio
- Department of Statistical Science, University College London, Gower St, London WC1E 6BT, UK
| | - Aurélien Belot
- Inequalities in Cancer Outcomes Network (ICON), Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| |
Collapse
|
4
|
Bailly L, Jobert T, Petrovic M, Pradier C. Factors influencing participation in breast cancer screening in an urban setting. A study of organized and individual opportunistic screening among potentially active and retired women in the city of Nice. Prev Med Rep 2022; 31:102085. [PMID: 36820373 PMCID: PMC9938307 DOI: 10.1016/j.pmedr.2022.102085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Participation in breast cancer screening in urban settings is poor. Identifying factors accounting for participation and non-participation is essential to target priority areas, tackle health inequalities and suggest innovative approaches. We studied organized and individual opportunistic participation in breast cancer screening within the 144 aggregated units for statistical information (Ilôts regroupés pour l'information statistique: IRIS) of the city of Nice from 2019 to 2021. In each IRIS was assessed a local human development index, among potentially active women aged 50 to 59 years and retired women aged 60 to 74 years. Modelling participation and non-participation in screening according to the IRIS units' socio-economical characteristics was performed using the SURE method (Seemingly Unrelated Regression Equations). Over a 2-year period, 24,396 breast screening tests were conducted (11,173 as organised screening, 13,223 as individual opportunistic screening). The local human development index was positively correlated with the two types of screening, respectively. Access to public transport facilitated participation. Managerial status was negatively correlated with organised screening. Single working women had a higher risk of non-participation. With regard to their socio-economic characteristics, screening rates were lower than expected in 16 IRIS units in the city of Nice. Local human development index, access to public transport, family and professional context appear to be associated with breast cancer screening in an urban setting. An innovative approach targeting these factors is called for to reduce health inequalities.
Collapse
Affiliation(s)
- Laurent Bailly
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Department of Public Health, UR2CA, Nice, France
- Corresponding author.
| | - Thomas Jobert
- Université Côte d'Azur, CNRS, GREDEG, 250 rue Albert Einstein, Valbonne 06560, France
| | - Mirko Petrovic
- Université Côte d’Azur, EUR ELMI, Rue du 22ème B.C.A., Nice 06300, France
| | - Christian Pradier
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Department of Public Health, UR2CA, Nice, France
| |
Collapse
|
5
|
Quintin C, Chatignoux E, Plaine J, Hamers FF, Rogel A. Coverage rate of opportunistic and organised breast cancer screening in France: Department-level estimation. Cancer Epidemiol 2022; 81:102270. [PMID: 36215917 DOI: 10.1016/j.canep.2022.102270] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/19/2022] [Accepted: 09/27/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In France, the national breast cancer screening programme (NBCSP), targeting women aged 50-74 years was rolled out nationwide in 2004. It aims at reducing breast cancer mortality. In addition to the NBCSP, the use of opportunistic screening is permitted in France. The objective of this study is to estimate both opportunistic use and overall coverage rates of breast cancer screening, among women 40-84 years of age, in France. METHODS The French medico-administrative health data system (SNDS) was used to identify women performing an opportunistic or organised mammography screening in France in 2016-2017. RESULTS The two-yearly opportunistic mammography screening is 18 % among women aged 40-84; it is 11 % among women aged 50-74, i.e., the target age range for organised screening, 36 % among women aged 40-49 and 13 % among women aged 75-84. The overall two-yearly screening coverage is 48 % for all women aged 40-84; it is 60 % among women aged 50-74, 36 % among women 40-49 and 16 % for those aged 75-84. Geographical variations in screening are lessened when the two screening strategies are considered, as they balance each other. CONCLUSION Although coverage in the NBCSP is around 50 % in France, more than one third of the women make use of opportunistic screening within and outside the target age range. Organized screening appears to improve equity of access to mammography screening service. The lack of data on opportunistic screening practices hinders the evaluation of French screening practices as a whole.
Collapse
Affiliation(s)
- Cécile Quintin
- National public health agency (Santé publique France), 12 rue du Val d'Osne, 94410 Saint Maurice, France.
| | - Edouard Chatignoux
- National public health agency (Santé publique France), 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Julie Plaine
- National public health agency (Santé publique France), 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Françoise F Hamers
- National public health agency (Santé publique France), 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Agnès Rogel
- National public health agency (Santé publique France), 12 rue du Val d'Osne, 94410 Saint Maurice, France
| |
Collapse
|
6
|
Quintal C, Antunes M. Mirror, mirror on the wall, when are inequalities higher, after all? Analysis of breast and cervical cancer screening in 30 European countries. Soc Sci Med 2022; 312:115371. [PMID: 36137367 DOI: 10.1016/j.socscimed.2022.115371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 07/01/2022] [Accepted: 09/11/2022] [Indexed: 10/31/2022]
Abstract
Screening for breast and cervical cancer is strongly related with a reduction in cancer mortality but previous evidence has found socioeconomic inequalities in screening. Using up-to-date data from the second wave of the European Health Interview Survey (2013-2015), this study aims to analyse income-related inequalities in mammography screening and Pap smear test in 30 European countries. We propose a framework that combines age group and screening interval, identifying situations of due-, under-, and over-screening. Coverage rates, standard and generalised concentration indices are calculated. Overall, pro-rich inequalities in screening persist though there are varied combinations of prevalence of screening attendance and relative inequality across countries. Bulgaria and particularly Romania stand out with low coverage and high inequality. Some Baltic and Mediterranean countries also present less favourable figures on both accounts. In general, there are not marked differences between mammography and Pap smear test, for the recommended situation ('Due-screening'). 'Extreme under-screening' is concentrated among lower income quintiles in basically all countries analysed, for both screenings. These women, who never screened, are at risk of entering the group of 'Lost opportunity', once they reach the upper-limit age of the target group. At the same time, there are signals of 'Over-screening', within target group, due to screening more frequently than recommended. In several countries, 'Over-screening' seems to be concentrated among richer women. This is not only a waste of resources, but it can also cause harms. The inequalities found in 'Extreme under-screening' and 'Over-screening' raise concerns on whether women are making informed choices.
Collapse
Affiliation(s)
- Carlota Quintal
- University of Coimbra, CeBER, Faculty of Economics, Portugal; CEISUC, Portugal.
| | - Micaela Antunes
- University of Coimbra, CeBER, Faculty of Economics, Portugal.
| |
Collapse
|
7
|
Sun Y, Ma Y, Cao M, Hu Z, Lin W, Chen M, He Y. Breast and cervical cancer screening adherence in Jiangsu, China: An ecological perspective. Front Public Health 2022; 10:967495. [PMID: 36033808 PMCID: PMC9403787 DOI: 10.3389/fpubh.2022.967495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/18/2022] [Indexed: 01/25/2023] Open
Abstract
Background High screening coverage can effectively reduce the mortality in breast and cervical cancer. Further research on extending the coverage of breast and cervical cancer screening in China is required. This study explored factors influencing women's "two-cancer" screening service utilization using an ecological approach. Methods Data were obtained from the National Health Services Survey (NHSS) conducted in 2018 in Jiangsu, China. A total of 3,500 women aged 18-64 years were included in the analysis. Chi-squared test, hierarchical multiple logistic regression analysis, and binary logistic regression analysis were performed. Results In total, 44.1% of the women had been screened for breast cancer (BC) and 40.9% for cervical cancer (CC). Breast cancer screening (BCS) and cervical cancer screening (CCS) differed significantly in the following common categories: age, gestational experiences, chronic disease status, body mass index (BMI), exercise, health checkup, marital status, number of children, employment, education, family doctors, and health records. In the results of hierarchical multiple logistic regression analysis, the explanatory power of the final model was 37.5% and the area under the receiver operating characteristic curve was 0.812. The results showed that being in the age group of 35-64 years, having gestational experiences, having chronic diseases, exercising, having a health checkup, being married, having children, and being employed were statistically significant positive predictors of "two-cancer" screening adherence. The household size was a barrier. For BCS, obesity was also a negative factor, and a higher overall self-related health status was a positive factor. Being married and living in households of three or more families were not predictors. For CCS, having health records was also positively significant, while having chronic disease did not influence adherence. Conclusion The findings provide an ecological explanation for women's BCS and CCS service utilization. Both proximal and distal factors should be considered to achieve a high coverage rate.
Collapse
Affiliation(s)
- Yanjun Sun
- Institute of Medical Humanities, Nanjing Medical University, Nanjing, China,School of Marxism, Nanjing Medical University, Nanjing, China
| | - Yuhao Ma
- Institute of Medical Humanities, Nanjing Medical University, Nanjing, China,School of Marxism, Nanjing Medical University, Nanjing, China
| | - Menghan Cao
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Zhiqing Hu
- Institute of Medical Humanities, Nanjing Medical University, Nanjing, China,School of Marxism, Nanjing Medical University, Nanjing, China
| | - Wei Lin
- Department of Students Affairs, Nanjing Medical University, Nanjing, China,Wei Lin
| | - Mingsheng Chen
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China,Mingsheng Chen
| | - Yuan He
- Institute of Medical Humanities, Nanjing Medical University, Nanjing, China,School of Marxism, Nanjing Medical University, Nanjing, China,Research Center for Social Risk Management of Major Public Health Events (Key Research Base of Philosophy and Social Sciences of Universities in Jiangsu), Nanjing Medical University, Nanjing, China,*Correspondence: Yuan He
| |
Collapse
|
8
|
Audiger C, Bovagnet T, Bardes J, Abihsera G, Nicolet J, Deghaye M, Bochaton A, Menvielle G. Social Inequalities in Participation in Cervical Cancer Screening in a Metropolitan Area Implementing a Pilot Organised Screening Programme (Paris Region, France). Int J Public Health 2022; 67:1604562. [PMID: 35859669 PMCID: PMC9289096 DOI: 10.3389/ijph.2022.1604562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/30/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives: We aimed to examine social inequalities in participation in cervical cancer screening (CCS) in a metropolitan area by implementing a pilot organised screening programme. The pilot programme consisted of sending invitations to women who did not perform a pap smear within the past 3 years, managing interventions to reach vulnerable women, training healthcare professionals, and organising follow-ups of abnormal pap smears. Methods: We studied participation in CCS between January 2014 and December 2016 among 241,257 women aged 25-63 years old. To assess relative inequalities, Odds Ratios were computed using multilevel logistic regression. To assess absolute inequalities, the CCS coverage and the rate difference were calculated. Inequalities were computed by age and neighbourhood characteristics (social deprivation and proportion of single women). Results: Disparities in participation in CCS were observed by age and social deprivation. For overall screening compared to opportunistic screening, disparities by age were larger (OR25-35_vs._55-64 = 2.13 [2.08-2.19] compared to 2.02 [1.96-2.07]), but disparities by social deprivation were decreased (OR10%_most_vs._10%_least_deprived = 2.09 [1.90-2.30] compared to 2.22 [2.02-2.44]). Conclusion: Disparities in CCS participation remain despite the organised programme. To reduce these inequalities, free screening should be proposed and evaluated.
Collapse
Affiliation(s)
- Céline Audiger
- Le Centre Régional de Coordination des Dépistages des Cancers-CRCDC, Paris, France
- Sorbonne Université, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Thomas Bovagnet
- Sorbonne Université, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Julia Bardes
- Le Centre Régional de Coordination des Dépistages des Cancers-CRCDC, Paris, France
| | - Gaëlle Abihsera
- Le Centre Régional de Coordination des Dépistages des Cancers-CRCDC, Paris, France
| | - Jérôme Nicolet
- Le Centre Régional de Coordination des Dépistages des Cancers-CRCDC, Paris, France
| | - Michel Deghaye
- Le Centre Régional de Coordination des Dépistages des Cancers-CRCDC, Paris, France
| | - Audrey Bochaton
- Université Paris Nanterre, UMR CNRS 7533 LADYSS, Nanterre, France
| | - Gwenn Menvielle
- Sorbonne Université, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| |
Collapse
|
9
|
Audiger C, Bovagnet T, Deghaye M, Kaufmanis A, Pelisson C, Bochaton A, Menvielle G. Factors associated with participation in the organized cervical cancer screening program in the greater Paris area (France): An analysis among more than 200,000 women. Prev Med 2021; 153:106831. [PMID: 34624389 DOI: 10.1016/j.ypmed.2021.106831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
We aimed to identify the contextual factors associated with participation in the organized Cervical Cancer Screening (CCS) pilot program, which includes specific interventions to reach vulnerable women, in the Greater Paris region. Study population consisted of 231,712 women aged 25-65 years, who were not up to date to their smear test and had been invited to take part in the program from July 2014 to September 2017. Using a multilevel mixed logistic regression with random effects, we investigated the effect of grassroots interventions targeting vulnerable women, healthcare provider accessibility, social environment and municipal policy-related factors. The CCS rate was two times higher in women who had received their first invitation to the program during the study period (32·9%) compared to those who were already invited before the study period (15·3%). In both populations, there were no significant trends in participation with regards to the type of grassroots interventions, level of accessibility of healthcare services or municipal commitment to healthcare. Among women invited previously and aged above 35 increased participation was seen in neighborhoods with low proportion of single women or in less deprived neighborhoods. Our results identified groups of women who participated less in the organized CCS program and suggested that additional interventions targeting the barriers faced by vulnerable women, especially those aged 35-45 years old, are needed.
Collapse
Affiliation(s)
- Céline Audiger
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), 27 rue Chaligny, F75012 Paris, France; Le Centre Régional de Coordination des Dépistages des Cancers- CRCDC-Région Ile de France, 8 place Adolphe Cherioux, 75015 Paris, France.
| | - Thomas Bovagnet
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), 27 rue Chaligny, F75012 Paris, France
| | - Michel Deghaye
- Le Centre Régional de Coordination des Dépistages des Cancers- CRCDC-Région Ile de France, 8 place Adolphe Cherioux, 75015 Paris, France
| | - Aldis Kaufmanis
- Le Centre Régional de Coordination des Dépistages des Cancers- CRCDC-Région Ile de France, 8 place Adolphe Cherioux, 75015 Paris, France
| | - Caroline Pelisson
- Le Centre Régional de Coordination des Dépistages des Cancers- CRCDC-Région Ile de France, 8 place Adolphe Cherioux, 75015 Paris, France
| | - Audrey Bochaton
- Université Paris Nanterre, UMR CNRS 7533 LADYSS, 200 Avenue de la République, 92000 Nanterre, France
| | - Gwenn Menvielle
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), 27 rue Chaligny, F75012 Paris, France
| |
Collapse
|
10
|
De Prez V, Jolidon V, Willems B, Cullati S, Burton-Jeangros C, Bracke P. Cervical cancer screening programs and their context-dependent effect on inequalities in screening uptake: a dynamic interplay between public health policy and welfare state redistribution. Int J Equity Health 2021; 20:211. [PMID: 34560888 PMCID: PMC8464130 DOI: 10.1186/s12939-021-01548-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While organized and opportunistic cervical cancer screening (CCS) programs implemented across the European Union have increased participation rates, barriers to socioeconomically deprived women remain substantial, implying high levels of inequality in CCS uptake. AIM This study assesses how the screening strategy (as a score based on the availability of organized population-based CCS programs), accessibility of the healthcare system (as an index of out-of-pocket expenditure as a proportion of total healthcare costs, public health expenditure as a percentage of total GDP, and general practitioner (GP) density per 10'000 inhabitants) and social protection (as a decommodification index), impact education- and income-based inequalities in CCS uptake. METHODS A two-level design with 25-64-year-old women (N = 96'883), eligible for Pap smear screening, nested in 28 European countries, was used to analyze data from the European Health Interview Survey's second wave, using multilevel logistic regression modelling. RESULTS Clear educational and income gradients in CCS uptake were found, which were smaller in countries with organized CCS programs, higher accessibility of the healthcare system and a higher level of decommodification. Furthermore, three-way interaction terms revealed that these gradients were smaller when organized CCS programs were implemented in countries with better accessibility of the healthcare system or a high level of decommodification. CONCLUSION This study indicates that the combination of organized screening and high accessibility of the healthcare system or social protection is essential for having lower levels of inequality in CCS uptake. In such countries, the structural threshold for poorer and lower educated women to engage in CCS is lower. This may be explained by them having a better interaction with their GP, who may convince them of the screening test, lower out-of-pocket payments, and financial support to buffer against a disadvantageous position on the labor market.
Collapse
Affiliation(s)
- Vincent De Prez
- Department of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium.
| | - Vladimir Jolidon
- Institute of Sociological Research, Geneva School of Social Sciences, University of Geneva, 40 bd du Pont-d'Arve, CH- 1211, Geneve 4, Switzerland
| | - Barbara Willems
- Department of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium
| | - Stéphane Cullati
- Institute of Sociological Research, Geneva School of Social Sciences, University of Geneva, 40 bd du Pont-d'Arve, CH- 1211, Geneve 4, Switzerland.,Population Health Laboratory, Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Ch. du Musée 8, CH-1700, Fribourg, Switzerland
| | - Claudine Burton-Jeangros
- Institute of Sociological Research, Geneva School of Social Sciences, University of Geneva, 40 bd du Pont-d'Arve, CH- 1211, Geneve 4, Switzerland
| | - Piet Bracke
- Department of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium
| |
Collapse
|
11
|
Gomes MLDS, Vieira NFC, Sousa DMDN, Moura NDS, Rodrigues IR, Rodrigues DP, Silva BGS, Oriá MOB. Health outcomes in women attending with clinical guideline PROGYNE to a primary care center for cervical cancer prevention. J Obstet Gynaecol Res 2021; 47:4371-4380. [PMID: 34505333 DOI: 10.1111/jog.15017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/04/2021] [Accepted: 08/28/2021] [Indexed: 12/24/2022]
Abstract
AIM The objective of the current study was to analyze the health outcomes of women attending with a clinical guideline to consultations for cervical cancer (CC) prevention in a primary care center. METHODS A cross-sectional design was used, and data were collected from March to July 2016 with a sample of 87 women in Fortaleza, Brazil. RESULTS The following correlations were found: previous history of sexually transmitted infection (p = 0.025), women who used oral contraceptives (p = 0.035), and undergo the Papanicolaou test annually; having black skin color (p = 0.031) and attending to the first gynecological consultation; being single (p = 0.031), family history of cancer (p < 0.001), and undergoing the first Papanicolaou test within the first 3 years of sexual activity; age up to 30 years and positive colposcopy (p = 0.027); and being single and positive colposcopy (p = 0.021). CC was characterized by the presence of intraepithelial lesion detected on colposcopy (gold standard). Receiver operating characteristic curves were used to evaluate the diagnostic accuracy of visual inspection with Lugol's iodine, digital cervicography, and Papanicolaou test. The area under the curve values were as follows: digital cervicography: 0.558, p = 0.509; Lugol's iodine: 0.491, p = 0.919; and Papanicolaou test: 0.697, p = 0.024. CONCLUSION Colposcopy in primary care provided a faster diagnosis of pre-cancerous lesions. Understanding the health outcomes of women who underwent consultations for CC prevention, as well as the screening and diagnosis methods used, is essential to the service and national health system of the less developed countries.
Collapse
|
12
|
Rollet Q, Guillaume É, Launay L, Launoy G. Socio-Territorial Inequities in the French National Breast Cancer Screening Programme-A Cross-Sectional Multilevel Study. Cancers (Basel) 2021; 13:cancers13174374. [PMID: 34503184 PMCID: PMC8430540 DOI: 10.3390/cancers13174374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 12/29/2022] Open
Abstract
Simple Summary France implemented a national breast cancer screening programme in 2004, which, despite recommendations, still coexists with opportunistic screening practices. We aimed to study socio-territorial inequities in participation in the 2013–2014 screening campaign, using multilevel models. With a representative sample of 42% of the estimated eligible population, we found that the organized programme does not erase social or territorial inequities in participation. Social inequities, at multiple levels, were found in nearly all départements, whereas territorial inequities seemed more context dependent. The impact of the coexistence with opportunistic screening, beyond any control and evaluation, is adding more risks (over-diagnosis, over-treatment) and leads to underestimating the true coverage of the population, mainly in the wealthiest, therefore leading to an underestimation of the true social gradient in participation. The French breast cancer screening programme needs to evolve to be more efficient in coverage, notably through the reduction of the unfair inequities in participation. Abstract Background. France implemented in 2004 the French National Breast Cancer Screening Programme (FNBCSP). Despite national recommendations, this programme coexists with non-negligible opportunistic screening practices. Aim. Analyse socio-territorial inequities in the 2013–2014 FNBCSP campaign in a large sample of the eligible population. Method. Analyses were performed using three-level hierarchical generalized linear model. Level one was a 10% random sample of the eligible population in each département (n = 397,598). For each woman, age and travel time to the nearest accredited radiology centre were computed. These observations were nested within 22,250 residential areas called “Îlots Regroupés pour l’Information Statistique” (IRIS), for which the European Deprivation Index (EDI) is defined. IRIS were nested within 41 départements, for which opportunistic screening rates and gross domestic product based on purchasing power parity were available, deprivation and the number of radiology centres for 100,000 eligible women were computed. Results. Organized screening uptake increased with age (OR1SD = 1.05 [1.04–1.06]) and decreased with travel time (OR1SD = 0.94 [0.93–0.95]) and EDI (OR1SD = 0.84 [0.83–0.85]). Between départements, organized screening uptake decreased with opportunistic screening rate (OR1SD = 0.84 [0.79–0.87]) and départements deprivation (OR1SD = 0.91 [0.88–0.96]). Association between EDI and organized screening uptake was weaker as opportunistic screening rates and as département deprivation increased. Heterogeneity in FNBCSP participation decreased between IRIS by 36% and between départements by 82%. Conclusion. FNBCSP does not erase socio-territorial inequities. The population the most at risk of dying from breast cancer is thus the less participating. More efforts are needed to improve equity.
Collapse
|
13
|
Caminada S, Turatto F, Iorio S, Paglione L, Errigo M, Mazzalai E, Jaljaa A, Giannini D, Tofani M, Michelazzo MB, Landi A, Napoli M, Brandimarte MA, Salvatori LM, Angelozzi A, Baglio G, Di Rosa E, Battisti A, Marceca M. Urban Health and Social Marginality: Perceived Health Status and Interaction with Healthcare Professionals of a Hard-to-Reach Community Living in a Suburban Area of Rome (Italy). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168804. [PMID: 34444550 PMCID: PMC8394967 DOI: 10.3390/ijerph18168804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022]
Abstract
The study reports an urban health investigation conducted in Bastogi, an outskirt of Rome (Italy) characterised by social marginalization and deprivation. Our aim was to analyse the health perception, health-related behaviours, and interaction with healthcare professionals of the inhabitants of Bastogi compared to the population living in the area of the same local health unit (ASL). The Progresses of Health Authorities for Health in Italy questionnaire (PASSI) was administered to a sample of 210 inhabitants of Bastogi. Data were analysed and compared to those of the ASL collected in 2017–2018. The socio-economic indicators showed an overall worse condition for the inhabitants of Bastogi, with a significantly higher proportion of foreign and unemployed residents and a lower educational level compared to the ASL. Significant differences in the prevalence of non-communicable diseases, mental health complaints, and participation in prevention strategies, including cancer screening, were found. The questionnaire showed a lower help-seeking behaviour and a lack of reliance on health professionals in Bastogi inhabitants. Our findings highlight how social determinants produce health inequities and barriers to accessing healthcare. The difficulties of conducting quantitative research in complex and hard-to-reach contexts, characterized by high social vulnerability, are outlined.
Collapse
Affiliation(s)
- Susanna Caminada
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.T.); (E.M.); (A.J.); (D.G.); (M.T.); (A.A.); (M.M.)
- Correspondence:
| | - Federica Turatto
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.T.); (E.M.); (A.J.); (D.G.); (M.T.); (A.A.); (M.M.)
| | - Silvia Iorio
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 00185 Rome, Italy;
| | - Lorenzo Paglione
- Department of Civil, Constructional and Environmental Engineering, Sapienza University of Rome, 00184 Rome, Italy;
- Department of Prevention, Local Health Unit Roma 1, 00135 Rome, Italy; (A.L.); (M.N.); (M.A.B.); (E.D.R.)
| | - Miriam Errigo
- Department of Social Sciences and Economics, Sapienza University of Rome, 00185 Rome, Italy;
| | - Elena Mazzalai
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.T.); (E.M.); (A.J.); (D.G.); (M.T.); (A.A.); (M.M.)
| | - Anissa Jaljaa
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.T.); (E.M.); (A.J.); (D.G.); (M.T.); (A.A.); (M.M.)
| | - Dara Giannini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.T.); (E.M.); (A.J.); (D.G.); (M.T.); (A.A.); (M.M.)
| | - Marco Tofani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.T.); (E.M.); (A.J.); (D.G.); (M.T.); (A.A.); (M.M.)
| | - Maria Benedetta Michelazzo
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Adelaide Landi
- Department of Prevention, Local Health Unit Roma 1, 00135 Rome, Italy; (A.L.); (M.N.); (M.A.B.); (E.D.R.)
| | - Massimo Napoli
- Department of Prevention, Local Health Unit Roma 1, 00135 Rome, Italy; (A.L.); (M.N.); (M.A.B.); (E.D.R.)
| | | | | | - Aurora Angelozzi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.T.); (E.M.); (A.J.); (D.G.); (M.T.); (A.A.); (M.M.)
| | - Giovanni Baglio
- Research and International Relations Office, Agenzia Nazionale per i Servizi Sanitari Regionali (AGENAS), 00187 Rome, Italy;
| | - Enrico Di Rosa
- Department of Prevention, Local Health Unit Roma 1, 00135 Rome, Italy; (A.L.); (M.N.); (M.A.B.); (E.D.R.)
| | - Alessandra Battisti
- Department of Planning, Design, and Technology of Architecture, Sapienza University of Rome, 00196 Rome, Italy;
| | - Maurizio Marceca
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.T.); (E.M.); (A.J.); (D.G.); (M.T.); (A.A.); (M.M.)
| |
Collapse
|
14
|
Aranda E, Franck JE, Ringa V, Sassenou J, Coeuret-Pellicer M, Rigal L, Menvielle G. Social inequalities in participation in cancer screening: does the mode of data collection matter? The CONSTANCES cohort. Eur J Public Health 2021; 31:602-608. [PMID: 34233352 DOI: 10.1093/eurpub/ckab055] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Self-reported data are prone to item non-response and misreporting. We investigated to what extent the use of self-reported data for participation in breast (BCS) and cervical cancer screening (CCS) impacted socioeconomic inequalities in cancer screening participation. METHODS We used data from a large population-based survey including information on cancer screening from self-reported questionnaire and administrative records (n = 14 122 for BCS, n = 27 120 CCS). For educational level, occupation class and household income per capita, we assessed the accuracy of self-reporting using sensitivity, specificity and both positive and negative predictive value. In addition, we estimated to what extent the use of self-reported data modified the magnitude of socioeconomic differences in BCS and CCS participation with age-adjusted non-screening rate difference, odds ratios and relative indices of inequality. RESULTS Although women with a high socioeconomic position were more prone to report a date for BCS and CCS in questionnaires, they were also more prone to over-declare their participation in CCS if they had not undergone a screening test within the recommended time frame. The use of self-reported cancer screening data, when compared with administrative records, did not impact the magnitude of social differences in BCS participation but led to an overestimation of the social differences in CCS participation. This was due to misreporting rather than to item non-response. CONCLUSIONS Women's socioeconomic position is associated with missingness and the accuracy of self-reported BCS and CCS participation. Social inequalities in cancer screening participation based on self-reports are likely to be overestimated for CCS.
Collapse
Affiliation(s)
- Ezequiel Aranda
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Research Team in Social Epidemiology, Paris, France
| | - Jeanna-Eve Franck
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Research Team in Social Epidemiology, Paris, France
| | - Virginie Ringa
- CESP Centre for Research in Epidemiology and Population Health, U1018, Gender, Sexuality and Health Team, University of Paris-Saclay, University of Paris-Sud, UVSQ, Villejuif, France.,Ined, Paris, France
| | - Jeanne Sassenou
- CESP Centre for Research in Epidemiology and Population Health, U1018, Gender, Sexuality and Health Team, University of Paris-Saclay, University of Paris-Sud, UVSQ, Villejuif, France.,Ined, Paris, France
| | - Mireille Coeuret-Pellicer
- Inserm, Versailles Saint Quentin en Yvelines University, UMS 011 "Epidemiological Population-Based Cohorts Unit", Villejuif, France
| | - Laurent Rigal
- CESP Centre for Research in Epidemiology and Population Health, U1018, Gender, Sexuality and Health Team, University of Paris-Saclay, University of Paris-Sud, UVSQ, Villejuif, France.,Ined, Paris, France
| | - Gwenn Menvielle
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Research Team in Social Epidemiology, Paris, France
| |
Collapse
|
15
|
Women with obesity in cervical cancer screening. The double penalty: Underscreening and income inequalities. Obes Res Clin Pract 2021; 15:212-215. [PMID: 33771444 DOI: 10.1016/j.orcp.2021.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/03/2021] [Indexed: 01/02/2023]
Abstract
The regular performance of Pap tests reduces the mortality of cervical cancer. Obesity is associated with low Pap test rates. We analyze the combined role of obesity and low income. We calculated a Slope Index of Inequality. Among the 28,905 women included, 23.1% were underscreened. The rate of underscreening increased with BMI. The income gradient increased significantly from 0.17 among normal-weight women to 0.19 in overweight and 0.23 in obese women (p = 0.047). Women who are obese are subject to a double penalty in cervical cancer screening: they are underscreened and subject to a more unfavorable economic gradient than normalweight women.
Collapse
|
16
|
Jones SMW, Schuler TA, Padamsee TJ, Andersen MR. Financial Anxiety is Associated With Cancer Screening Adherence in Women at High Risk of Breast Cancer. Ann Behav Med 2021; 55:1241-1245. [PMID: 33761532 DOI: 10.1093/abm/kaab010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous studies have examined the impact of material financial hardship on cancer screening but without focusing on the psychological aspects of financial hardship. PURPOSE This study examined the effects of different types of financial anxiety on adherence to breast cancer screening in women at high risk of breast cancer. Adherence to cervical cancer screening was also examined to determine whether associations between financial anxiety and screening adherence were unique to breast cancer screening or more general. METHODS Women (n = 324) aged 30-50 and at high risk for inherited breast cancer completed a survey on general financial anxiety, worry about affording healthcare, financial stigma due to cancer risk, and adherence to cancer screening. Multivariate analyses controlled for poverty, age, and race. RESULTS More financial anxiety was associated with lower odds of mammogram adherence (odds ratio [OR] = 0.97, confidence interval [CI] = 0.94, 0.99), Pap smear adherence (OR = 0.98, CI = 0.96, 0.996), and clinical breast examination adherence (OR = 0.98, CI = 0.96, 0.995). More worry about affording healthcare was associated with lower odds of clinical breast examination adherence (OR = 0.95, CI = 0.91, 0.9992) but not mammogram or Pap smear adherence (p > .05). Financial stigma due to cancer risk was associated with lower odds of Pap smear adherence (OR = 0.87, CI = 0.77, 0.97) but no other cancer screenings (p > .07). CONCLUSIONS Financial anxiety may impede cancer screening, even for high-risk women aware of their risk status. Clinical interventions focused on social determinants of health may also need to address financial anxiety for women at high risk of breast cancer.
Collapse
Affiliation(s)
- Salene M W Jones
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Tammy A Schuler
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Tasleem J Padamsee
- The Ohio State University College of Public Health and James Comprehensive Cancer Center, Columbus, OH, USA
| | - M Robyn Andersen
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| |
Collapse
|
17
|
de la Motte Rouge T, Touboul C, Lhomel C, Rouprêt M, Morère JF. Factors associated with compliance to cervical cancer screening in France: The EDIFICE 6 survey. Gynecol Oncol 2020; 160:112-117. [PMID: 33158509 DOI: 10.1016/j.ygyno.2020.10.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/25/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION A nationwide cervical cancer (CC) screening program was implemented in France in 2018. Asymptomatic women are invited for a cytological test once every 3 years (age, 25-29 years), and an HPV test every 5 years (age, 30-65 years). We investigated the characteristics of women who are resistant to CC screening. METHODS Since 2005, the EDIFICE survey program has assessed attitudes toward cancer screening in France. The 6th edition (2017) included 12,046 representative women (age, 18-69 years). Social vulnerability was assessed using the EPICES score. Multivariate stepwise logistic regression analysis identified factors correlated with nonuptake of CC screening. RESULTS Questionnaires from 4499 women (age, 25-65 years) with no history of cancer were analyzed; 88% (N = 3960) reported at least one test in their lifetime, and 73% (N = 3262) did the test in the previous 3 years. Compared to ever-screened women, never-screened women were younger (38 ± 11 yrs. vs 44 ± 12 yrs., P < 0.05), and more likely to be single (48% vs 20%, P < 0.05) and/or socially vulnerable (59% vs 38%, P < 0.05). In multivariate analysis, items significantly (P < 0.05) associated with never screening included living alone (OR = 2.26, 95% CI [1.85-2.75]) and social vulnerability (OR = 1.95 [1.59-2.40]). Women who were not compliant with recommendations were more likely to be older (mean age, 49.2 yrs. vs. 43.2 yrs), living alone (single, widowed or divorced, 40% vs. 30%, P < 0.05), and/or socially vulnerable (55% vs. 35%, P < 0.05; OR = 1.78, 95% CI [1.49-2.12]). CONCLUSION This analysis identified several factors associated with never screening and under-screening. Effective prevention messages should specifically target these populations.
Collapse
Affiliation(s)
| | | | | | - Morgan Rouprêt
- Sorbonne Université, GRC n°5, Oncotype-URO, Assistance Publique - Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, 75 013, Paris, France
| | | |
Collapse
|
18
|
Bertucci M, Bonnet E, Satger L, Kreiche A, Chappert JL, Loy-Morel S, Segondy M, Daurès JP, Boulle N. Acceptability of vaginal self-sampling with high-risk human papillomavirus testing for cervical cancer screening: a French questionnaire-based study. Women Health 2020; 61:83-94. [PMID: 33106125 DOI: 10.1080/03630242.2020.1831683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In France, cervical cancer screening based on cervical smear has a participation rate of around 60%. New screening strategies are encouraged to increase the participation of under-screened women, including vaginal self-sampling with high-risk human papillomavirus (HR-HPV) testing. This study was based on the distribution of an anonymous self-administered questionnaire to assess the acceptability of vaginal self-sampling with HR-HPV testing by women aged 25 to 65 years in two French Departments of the South of France, Aude, and Hérault, showing low participation in cervical cancer screening. Factors influencing this acceptability were also analyzed. From May to July 2017, 349 completed questionnaires were collected. Women declared high acceptability for vaginal self-sampling (81%) preferably at home (82.6%). Acceptability was statistically higher in the Department of Herault (p = .001) and for women older than 50 years (p = .018). There was no difference according to educational level or attendance to cervical cancer screening. Knowledge about cervical cancer and cervical cancer screening was significantly influenced by educational level. This study confirmed that vaginal self-sampling with HR-HPV testing was highly accepted, including by under-screened women, encouraging further interventional studies. Education about cervical cancer and cervical cancer screening should be part of these programs, especially for women with lower educational level.
Collapse
Affiliation(s)
- Martina Bertucci
- Department of Midwifery Studies, University of Montpellier , Montpellier, France
| | - Emmanuel Bonnet
- UPRES EA2415 Clinical Research University Institute, University of Montpellier , Montpellier, France
| | - Laura Satger
- Department of Gynecology and Obstetrics, CHU Montpellier , Montpellier, France
| | - Antoine Kreiche
- Department of Aude, Regional Coordinating Center for Cancer Screening, Occitanie , Carcassonne, France
| | - Jean-Loup Chappert
- Department of Hérault, Regional Coordinating Center for Cancer Screening, Occitanie , Montpellier, France
| | - Silvia Loy-Morel
- Department of Herault, Association for Breast Cancer Screening in Montpellier-Hérault (AMHDCS) , Montpellier, France
| | - Michel Segondy
- Pathogenesis and Control of Chronic Infections, University of Montpellier, INSERM, EFS, CHU Montpellier , Montpellier, France
| | - Jean Pierre Daurès
- UPRES EA2415 Clinical Research University Institute, University of Montpellier , Montpellier, France
| | - Nathalie Boulle
- Pathogenesis and Control of Chronic Infections, University of Montpellier, INSERM, EFS, CHU Montpellier , Montpellier, France.,Department of Pathology and Oncobiology, Laboratory of Solid Tumors, CHU Montpellier , Montpellier, France
| |
Collapse
|
19
|
Tran TVT, Franck JE, Cœuret-Pellicer M, Rigal L, Ringa V, Menvielle G. Combined Effect of Health Status and Primary Care Use on Participation in Cancer Screening: The CONSTANCES Cohort. WOMEN'S HEALTH REPORTS 2020; 1:511-520. [PMID: 35982989 PMCID: PMC9380874 DOI: 10.1089/whr.2020.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 11/15/2022]
Abstract
Background: The combined association between primary care utilization and health status with breast cancer screening (BCS) and cervical cancer screening (CCS) remains unclear. Our aim was to identify women's profiles based on their health status and primary care utilization and study their associated adherence to BCS and CCS recommendations. Methods: Using data from the cohort of people visiting health screening centers (CONSTANCES) in France (2012–2015), we first identified women's profiles based on their health status (self-perceived health, physical, and mental health) and primary care utilization (visit to the General Practitioner [GP], uptake of blood tests) using a multiple correspondence analysis and a hierarchical cluster analysis. We then investigated the association of these profiles to BCS and CCS using logistic regression models adjusted for age, smoking status, sociodemographic and socioeconomic characteristics, and the regularity of gynecologist consultation. Results: We identified five distinct profiles of women with contrasted participation in BCS (n = 14,122) and CCS (n = 27,120). In multivariate analyses, cancer screening participation increased from women with very good health and poor primary care utilization, to those with poor health and frequent visits to the GP, and those with very good health and average primary care utilization. The most favorable profiles regarding cancer screening rates were women with average-to-poor health and regular visits to the GP and uptake of blood tests. Conclusions: Our results suggest that policies aiming at increasing cancer screening participation should simultaneously account for women's use of primary care and health and consider more specific subgroups than what is usually done. Further research should investigate factors motivating cancer screening practice, such as women's beliefs regarding cancer screening and women's psychological characteristics.
Collapse
Affiliation(s)
- Thi-Van-Trinh Tran
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Jeanna-Eve Franck
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Mireille Cœuret-Pellicer
- Inserm-Versailles Saint Quentinen Yvelines University, UMS 011 “Epidemiological Population-Based Cohorts Unit,” Villejuif, France
| | - Laurent Rigal
- CESP Centre for Research in Epidemiology and Population Health, U1018, Gender, Sexuality and Health Team, University of Paris-Saclay, University of Paris-Sud, UVSQ, Villejuif, France
- Ined, Paris, France
| | - Virginie Ringa
- CESP Centre for Research in Epidemiology and Population Health, U1018, Gender, Sexuality and Health Team, University of Paris-Saclay, University of Paris-Sud, UVSQ, Villejuif, France
- Ined, Paris, France
| | - Gwenn Menvielle
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| |
Collapse
|
20
|
Serman F, Favre J, Deken V, Guittet L, Collins C, Rochoy M, Messaadi N, Duhamel A, Launay L, Berkhout C, Raginel T. The association between cervical cancer screening participation and the deprivation index of the location of the family doctor's office. PLoS One 2020; 15:e0232814. [PMID: 32413044 PMCID: PMC7228108 DOI: 10.1371/journal.pone.0232814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 04/21/2020] [Indexed: 11/26/2022] Open
Abstract
Background Cervical cancer screening rates are known to be strongly associated with socioeconomic status. Our objective was to assess whether the rate is also associated with an aggregated deprivation marker, defined by the location of family doctors’ offices. Methods To access this association, we 1) collected data from the claim database of the French Health Insurance Fund about the registered family doctors and their enlisted female patients eligible for cervical screening; 2) carried out a telephone survey with all registered doctors to establish if they were carrying out Pap-smears in their practices; 3) geotracked all the doctors’ offices in the smallest existing blocks of socioeconomic homogenous populations (IRIS census units) that were assigned a census derived marker of deprivation, the European Deprivation Index (EDI), and a binary variable of urbanization; and 4) we used a multivariable linear mixed model with IRIS as a random effect. Results Of 348 eligible doctors, 343 responded to the telephone survey (98.6%) and were included in the analysis, encompassing 88,152 female enlisted patients aged 25–65 years old. In the multivariable analysis (adjusted by the gender of the family doctor, the practice of Pap-smears by the doctor and the urbanization of the office location), the EDI of the doctor’s office was strongly associated with the cervical cancer screening participation rate of eligible patients (p<0.001). Conclusion The EDI linked to the location of the family doctor’s office seems to be a robust marker to predict female patients’ participation in cervical cancer screening.
Collapse
Affiliation(s)
- Fanny Serman
- Department of General Medicine, School of Medicine, Lille University, Lille, France
- * E-mail:
| | - Jonathan Favre
- Department of General Medicine, School of Medicine, Lille University, Lille, France
| | - Valérie Deken
- Department of Public Health, University Hospital of Lille, Lille University, Lille, France
| | - Lydia Guittet
- Department of Epidemiological Research and Evaluation, University Hospital Caen, Caen, France
- INSERM U1086 « Anticipe », University Hospital Caen, Normandie University, Caen, France
- Department of General Medicine, Medical School, Normandie University, Caen, France
| | | | - Michaël Rochoy
- Department of General Medicine, School of Medicine, Lille University, Lille, France
| | - Nassir Messaadi
- Department of General Medicine, School of Medicine, Lille University, Lille, France
| | - Alain Duhamel
- Department of Public Health, University Hospital of Lille, Lille University, Lille, France
| | - Ludivine Launay
- Department of Epidemiological Research and Evaluation, University Hospital Caen, Caen, France
- INSERM U1086 « Anticipe », University Hospital Caen, Normandie University, Caen, France
- Department of General Medicine, Medical School, Normandie University, Caen, France
| | - Christophe Berkhout
- Department of General Medicine, School of Medicine, Lille University, Lille, France
| | - Thibaut Raginel
- INSERM U1086 « Anticipe », University Hospital Caen, Normandie University, Caen, France
- Department of General Medicine, Medical School, Normandie University, Caen, France
| |
Collapse
|
21
|
Grimley CE, Kato PM, Grunfeld EA. Health and health belief factors associated with screening and help-seeking behaviours for breast cancer: A systematic review and meta-analysis of the European evidence. Br J Health Psychol 2019; 25:107-128. [PMID: 31876992 DOI: 10.1111/bjhp.12397] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 10/28/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this systematic review was to identify health or health belief factors associated with mammography attendance or with self-initiated medical help-seeking for breast cancer symptoms among women in Europe. METHODS Five databases were searched for articles published between 2005 and 2018. Meta-analyses were conducted for 13 factors related to screening attendance and two factors associated with help-seeking behaviour. Where there were too few studies to include in the meta-analysis, a narrative synthesis was undertaken. RESULTS Sixty-five studies were included. Never having had cervical screening (d = -.72, p < .001) and higher perceived barriers to mammography (d = -.40, p < .001) were associated with lower levels of screening attendance. Possessing health insurance (d = .49, p < .001), greater perceived benefits (d = .31, p < .001) and motivation (d = .36, p = .003) towards screening, and higher perceived seriousness (d = .24, p = .019) and susceptibility (d = .20, p = .024) towards breast cancer were associated with a higher level of screening attendance. Presenting with a non-lump symptom was associated with a longer time to presentation (d = .32, p < .001). The narrative synthesis revealed that previous benign breast disease was associated with a higher level of screening attendance but with a longer time to presentation. CONCLUSIONS The review identified key similarities in factors associated with screening and help-seeking behaviours which offer scope for combined interventions aimed at women that target both behaviours. Furthermore, the review highlighted that fewer studies have focused on help-seeking behaviour, despite two thirds of breast cancer cases being self-detected. Future research should further examine predictors of help-seeking behaviour including a focus on modifiable factors, such as BMI, and physical activity.
Collapse
Affiliation(s)
| | - Pamela M Kato
- P. M. Kato Consulting, Mountain View, California, USA
| | - Elizabeth A Grunfeld
- Department of Psychological Sciences, Birkbeck College, University of London, UK
| |
Collapse
|
22
|
Shaaban AN, Morais S, Peleteiro B. Healthcare Services Utilization Among Migrants in Portugal: Results From the National Health Survey 2014. J Immigr Minor Health 2019; 21:219-229. [PMID: 29644552 DOI: 10.1007/s10903-018-0744-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Migrants' health is attracting substantial global interest. We aimed to identify barriers and differences in healthcare services utilization between migrants and natives in a nationally representative sample using data from the National Health Survey 2014. A total of 18,165 participants providing information on country of birth and nationality were included, and comparison of healthcare services utilization was made by using participants born in Portugal and with Portuguese nationality as the reference group. Migrants reported a lower frequency of medical visits, a higher consumption of medication without a prescription and less use of preventive care services. The main reasons for not attending medical consultations among migrants were the absence of need and financial difficulties. This study illustrates inequalities in healthcare use among migrants in Portugal, and provides useful information for enlightening policymakers and healthcare providers to develop health policies that can address migrants' needs.
Collapse
Affiliation(s)
- A Nabil Shaaban
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Samantha Morais
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Bárbara Peleteiro
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| |
Collapse
|
23
|
Kriaucioniene V, Petkeviciene J. Predictors and Trend in Attendance for Breast Cancer Screening in Lithuania, 2006-2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224535. [PMID: 31744058 PMCID: PMC6887946 DOI: 10.3390/ijerph16224535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 12/24/2022]
Abstract
In Lithuania, a Nationwide Breast Cancer (BC) Screening Program was launched in 2005, offering mammography for women aged 50 to 69 years, every other year. This study aimed to determine the trend in the attendance for mammography screening during 2006–2014 and to identify the factors that are predictive for participation in it. The study sample consisted of 1941 women aged 50–64 years, who participated in five cross-sectional biennial postal surveys of Lithuanian Health Behavior Monitoring, carried out in independent national random samples. The attendance for screening was identified if women reported having had a mammogram within the last two years. The proportion of women attending the screening was continuously increasing from 20.0% in 2006 up to 65.8% in 2014. The attendance for BC screening was associated with the participation in cervical cancer screening. A higher level of education, living in a city, frequent contact with a doctor, and healthy behaviors (fresh-vegetable consumption, physical activity, and absence of alcohol abuse) were associated with higher participation rates in BC screening. To increase BC screening uptake and to reduce inequalities in attendance, new strategies of organized BC screening program using systematic personal invitations are required in Lithuania.
Collapse
|
24
|
Padilla CM, Painblanc F, Soler-Michel P, Vieira VM. Mapping Variation in Breast Cancer Screening: Where to Intervene? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2274. [PMID: 31252599 PMCID: PMC6651541 DOI: 10.3390/ijerph16132274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/07/2019] [Accepted: 06/22/2019] [Indexed: 11/24/2022]
Abstract
Small geographic areas with lower mammography screening participation rates may reflect gaps in screening efforts. Our objective was to use spatial analyses to understand disparities in mammography screening use and to identify factors to increase its uptake in areas that need it in Lyon metropolitan area, France. Data for screened women between the ages of 50 and 74 were analyzed. Census blocks of screened and non screened women were extracted from the mammography screening programme 2015-2016 dataset. We used spatial regression models, within a generalized additive framework to determine clusters of census blocks with significantly higher prevalence of non-participation of mammography screening. Smoothed risk maps were crude and adjusted on the following covariates: deprivation index and opportunistic screening. Among 178,002 women aged 50 to 74, 49.9% received mammography screening. As hypothesized, women living in highly deprived census blocks had lower participation rates compared to less deprived blocks, 45.2% vs. 51.4% p < 0.001. Spatial analyses identified four clusters, one located in an urban area and three in suburban areas. Moreover, depending on the location of the cluster, the influence came from different variables. Knowing the impact of site-specific risk factors seems to be important for implementing an appropriate prevention intervention.
Collapse
Affiliation(s)
- Cindy M Padilla
- Université Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449 Rennes, France.
| | - François Painblanc
- Université Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449 Rennes, France
| | - Patricia Soler-Michel
- Centre régional de coordination des dépistages des cancers Auvergne Rhône Alpes, 5 bis, rue Cléberg, 69322 Lyon CEDEX 05, France
| | - Veronica M Vieira
- Program in Public Health, University of California, Irvine, CA 92697, USA
| |
Collapse
|
25
|
Rukhadze L, Lunet N, Peleteiro B. Cervical cytology use in Portugal: Results from the National Health Survey 2014. J Obstet Gynaecol Res 2019; 45:1286-1295. [PMID: 31034140 DOI: 10.1111/jog.13974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 04/03/2019] [Indexed: 11/28/2022]
Abstract
AIM Given the disparities across regional cervical cancer screening programs implemented in Portugal, understanding the patterns of cervical cytology use is essential to improve cervical cancer control. We aimed to describe the use of cervical cytology and identify factors associated with its non- and underuse. METHODS A total of 5884 women aged 25-64 years were evaluated as part of the National Health Survey 2014. Previous use of cervical cytology was classified as never or ever, and ever-users having undergone the latest testing more than 5 years before were considered under-users. We computed age- and education-adjusted prevalence ratios and corresponding 95% confidence intervals for non- and underuse. RESULTS Overall, 13.2 and 12.0% of women reported nonuse and underuse of cervical cytology, respectively. The Norte region presented the lowest prevalence of nonuse and R.A. Açores the highest. Low socioeconomic status and unhealthy lifestyles were significantly associated with low cervical cytology use, whereas greater use was observed in those having more recent contact with health services. CONCLUSIONS Cervical cytology use was shown to differ according to sociodemographic characteristics and access to/use of healthcare services. Large regional variations persist in Portugal despite organized screening programs that cover most of the country.
Collapse
Affiliation(s)
- Londa Rukhadze
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Bárbara Peleteiro
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| |
Collapse
|
26
|
Açucena Vieira Alves S, Schiaveto de Souza A, Weller M, Pires Batiston A. Differential Impact of Education Level, Occupation and
Marital Status on Performance of the Papanicolaou Test among
Women from Various Regions in Brazil. Asian Pac J Cancer Prev 2019; 20:1037-1044. [PMID: 31030471 PMCID: PMC6948916 DOI: 10.31557/apjcp.2019.20.4.1037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: In Brazil, little is known regarding the underlying causes of differences among populations regarding socio-economic variables that affect women’s cervical cancer screening behavior. The present study focused on socio-economic variables that affect women’s performance of the Papanicolaou test, comparing two distinct Brazilian populations. Methods: We collected data regarding performance of the Papanicolaou test and socio-economic variables from 559 women in Mato Grosso do Sul (MS), in the Central East region, and 338 women in Paraíba (PB), in the Northeast region of Brazil. Nominal logistic regression modeling was performed to identify independent variables for both groups of data. Results: Of the women interviewed from MS and PB, 116 out of 599 (19.37%) and 94 out of 338 (27.81%), respectively, had not performed the Papanicolaou test within the last three years (p = 0.025). Low educational level characterized 570 (95.16%) and 203 (60.06%) of women from MS and PB, respectively (p = 0.000). Women in PB who had a low educational level and were unemployed had a 2.96-fold (OR = 0.338; 95% CI: 0.121 - 0.939) and 2.40-fold (OR = 0.416; 95% CI: 0.199 - 0.869) lower chance, respectively, to have performed the Papanicolaou test ≥ three times, or once within the last three years (p = 0.029; p = 0.014). The chance of women in MS who did not live in a stable relationship to have performed the test ≥ three times was 1.79-fold (OR = 0.560; 95% CI: 0.348 – 0.901) lower compared to women who reported a stable relationship (p = 0.039). Conclusions: High educational level, employment, and having a stable interpersonal relationship positively associated with performance of the Papanicolaou test among women in PB and MS. Despite having predominantly a low educational level, women in MS performed the Papanicolaou test more frequently than those in PB.
Collapse
Affiliation(s)
| | - Albert Schiaveto de Souza
- Institute of Biosciences, Federal University of Mato Grosso do Sul (UFMS), Campo Grande- Mato Grosso do Sul, Brazil
| | - Mathias Weller
- Postgraduate Program in Public Health, State University of Paraíba (UEPB), Campina Grande, Paraíba, Brazil.
| | - Adriane Pires Batiston
- Instituto Integrado de Saúde, Federal University of Mato Grosso do Sul (UFMS), Campo Grande- Mato Grosso do Sul, Brazil
| |
Collapse
|
27
|
Abstract
In France, cervical cancer screening is recommended every 3 years for women aged 25-65 years. With the exception of a few local organized programs, screening is mainly opportunistic. In view of setting up a nationwide population-based organized screening program, a pilot intervention was implemented in nine geographic areas using a common protocol. Women aged 25-65 years who had not undergone a cytological screening in the past 3 years were invited for screening during 2010-2012 and reminded up to 1 year after the initial invitation. Cytological results and follow-up data were collected up to the end of 2014 for all women screened irrespective of whether spontaneously or following invitation. Aggregate data were centralized nationally. Among the 2.4 million women from the total target population aged 25-65 years, 1.3 million were invited for screening. The overall screening coverage during 2010-2012 was 62.3%, with wide variations across geographic areas, ranging from 41.6 to 72.5%. Initial invitations and reminders enabled nearly 280 000 women to be screened, corresponding to an estimated increase in coverage of 12% points. Overall, 4.2% of the women screened had an abnormal smear. A total of 5180 high-grade cervical precancers and 323 invasive cervical cancers were reported, corresponding to detection rates of, respectively, 623 and 39 per 100 000 women screened 3-yearly. This study indicates that such organized screening may markedly improve the uptake of cervical cancer screening. On the basis of this pilot program, nationwide organized cervical cancer screening is currently being rolled out in France.
Collapse
|
28
|
Tron L, Belot A, Fauvernier M, Remontet L, Bossard N, Launay L, Bryere J, Monnereau A, Dejardin O, Launoy G. Socioeconomic environment and disparities in cancer survival for 19 solid tumor sites: An analysis of the French Network of Cancer Registries (FRANCIM) data. Int J Cancer 2019; 144:1262-1274. [PMID: 30367459 DOI: 10.1002/ijc.31951] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/14/2018] [Accepted: 10/18/2018] [Indexed: 01/02/2023]
Abstract
Social inequalities are concerning along the cancer continuum. In France, social gradient in health is particularly marked but little is known about social gradient in cancer survival. We aimed to investigate the influence of socioeconomic environment on cancer survival, for all cancers reported in the French Network of Cancer Registries. We analyzed 189,657 solid tumors diagnosed between 2006 and 2009, recorded in 18 registries. The European Deprivation Index (EDI), an ecological index measuring relative poverty in small geographic areas, assessed social environment. The EDI was categorized into quintiles of the national distribution. One- and five-year age-standardized net survival (ASNS) were estimated for each solid tumor site and deprivation quintile, among men and among women. We found that 5-year ASNS was lower among patients living in the most deprived areas compared to those living in the least deprived ones for 14/16 cancers among men and 16/18 cancers among women. The extent of cancer survival disparities according to deprivation varied substantially across the cancer sites. The reduction in ASNS between the least and the most deprived quintile reached 34% for liver cancer among men and 59% for bile duct cancer among women. For pancreas, stomach and esophagus cancer (among men), and ovary and stomach cancer (among women), deprivation gaps were larger at 1-year than 5-year survival. In conclusion, survival was worse in the most deprived areas for almost all cancers. Our results from population-based cancer registries data highlight the need for implementing actions to reduce social inequalities in cancer survival in France.
Collapse
Affiliation(s)
- Laure Tron
- University Hospital of Caen, Caen cedex, France; 'ANTICIPE' U1086 INSERM-UCN, Team labeled 'Ligue Contre le Cancer', Centre François Baclesse, Caen, France
| | - Aurélien Belot
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mathieu Fauvernier
- Service de Biostatistique et de Bioinformatique, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Laurent Remontet
- Service de Biostatistique et de Bioinformatique, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Nadine Bossard
- Service de Biostatistique et de Bioinformatique, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Ludivine Launay
- 'ANTICIPE' U1086 INSERM-UCN, Team labeled 'Ligue Contre le Cancer', Centre François Baclesse, Caen, France
| | - Joséphine Bryere
- 'ANTICIPE' U1086 INSERM-UCN, Team labeled 'Ligue Contre le Cancer', Centre François Baclesse, Caen, France
| | - Alain Monnereau
- Registre des hémopathies malignes de la Gironde, Institut Bergonié, Bordeaux, France
- French Network of Cancer Registries, Toulouse, France
| | - Olivier Dejardin
- University Hospital of Caen, Caen cedex, France; 'ANTICIPE' U1086 INSERM-UCN, Team labeled 'Ligue Contre le Cancer', Centre François Baclesse, Caen, France
| | - Guy Launoy
- University Hospital of Caen, Caen cedex, France; 'ANTICIPE' U1086 INSERM-UCN, Team labeled 'Ligue Contre le Cancer', Centre François Baclesse, Caen, France
- French Network of Cancer Registries, Toulouse, France
| |
Collapse
|
29
|
Crampe-Casnabet C, Franck JE, Ringa V, Coeuret-Pellicer M, Chauvin P, Menvielle G. Role of obesity in differences in cervical cancer screening rates by migration history. The CONSTANCES survey. Cancer Epidemiol 2018; 58:98-103. [PMID: 30530110 DOI: 10.1016/j.canep.2018.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/02/2018] [Accepted: 11/27/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Immigrant women often have lower cervical cancer screening (CCS) rates, tend to have a higher body mass index (BMI) and may be more vulnerable to BMI-related stigmatization. Our aim was to assess the role of BMI in differences in CCS rates by migration history. METHODS Analyses were based on the 2012-2015 inclusion data (n = 27,226) for the population-based CONSTANCES cohort, including detailed, self-reported information on demographics and socioeconomic characteristics, migration history, health behaviours, health, and health care use. Measured BMI (underweight (<18.5), normal-weight (18.5-25), overweight (25-30), obese (>30)) was collected. Poisson regression models with robust variance were conducted to assess the contribution of BMI to differences in CCS rates by migration history, and analyses stratified by BMI were done. Multiple imputations were performed. RESULTS The CCS rates ranged from 87% among French-born women with two French parents to 86% among French-born women with at least one parent of foreign origin, 82% among naturalized immigrants and 74% among non-naturalized immigrants. After adjusting for covariates, non-naturalized immigrants showed an 11% (95% CI: 8%-14%) lower CCS rate than French-born women with two French parents. Adjusting for BMI did not change the estimates. When stratifying by BMI category, non-naturalized immigrants showed an 11% (7%-14%) lower CCS rate then French-born with two French parents when normal weight, a 9% (2%-16%) lower CCS rate when overweight, and an 18% (5%-30%) lower CCS rate when obese. CONCLUSION Migration history and BMI jointly impact CCS rates. They were lower among all non-naturalized immigrants, particularly those who were obese.
Collapse
Affiliation(s)
- Cyrielle Crampe-Casnabet
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Department of social epidemiology, F75012 Paris, France.
| | - Jeanna-Eve Franck
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Department of social epidemiology, F75012 Paris, France.
| | - Virginie Ringa
- CESP, INSERM U1018, Univ Paris-Saclay, Univ Paris-Sud, UVSQ, Villejuif, France.
| | - Mireille Coeuret-Pellicer
- Inserm, Population-based Epidemiologic Cohorts Unit, UMS 011, Villejuif, France; University of Versailles St-Quentin, UMRS 1018, Villejuif, France.
| | - Pierre Chauvin
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Department of social epidemiology, F75012 Paris, France.
| | - Gwenn Menvielle
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Department of social epidemiology, F75012 Paris, France.
| |
Collapse
|
30
|
Darquy S, Moutel G, Jullian O, Barré S, Duchange N. Towards equity in organised cancer screening: the case of cervical cancer screening in France. BMC WOMENS HEALTH 2018; 18:192. [PMID: 30477482 PMCID: PMC6258288 DOI: 10.1186/s12905-018-0683-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 11/09/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND The French national cancer institute (INCa) conducted a series of studies to assist decision-making in view of the implementation of organised cervical cancer screening that will be launched in 2018. The programme will concern all women aged 25-65 and targeted interventions will be developed for underscreened populations. This is an evolution from an equality-based approach to a step-by-step strategy of equity aiming to tackle health cancer inequalities that are avoidable and represents unfair differences. Here we present the work of the expert-group in ethics drafted by INCa to review the ethical issues prior to the programme implementation. DISCUSSION We discuss the value of such a strategy and presents reflections with regard to issues of stigmatization, respect for individual freedom and autonomy. Indeed, the balance has to be found between the search for beneficence and the potential occurrence of perverse effects, which should be considered with particular attention. CONCLUSION Moving toward an equity-oriented policy under a strategy of proportionate universalism faces a number of challenges, thus an overview of ethics and social sciences must be an integral part of the process.
Collapse
Affiliation(s)
- Sylviane Darquy
- Univ. Bordeaux, Inserm U1219, EPICENE, Cancer et expositions environnementales, 33000, Bordeaux, France
| | - Grégoire Moutel
- Normandie univ, UNICAEN, Inserm U1086, ANTICIPE, 14000, Caen, France.,Espace régional d'éthique, CHU de Caen, Normandie Université, 14000, Caen, France
| | - Odile Jullian
- Institut National du Cancer, 92513, Boulogne-Billancourt, France
| | - Stéphanie Barré
- Institut National du Cancer, 92513, Boulogne-Billancourt, France
| | - Nathalie Duchange
- Normandie univ, UNICAEN, Inserm U1086, ANTICIPE, 14000, Caen, France.
| |
Collapse
|
31
|
Hu R, Wang MQ, Niu WB, Wang YJ, Liu YY, Liu LY, Wang M, Zhong J, You HY, Wu XH, Deng N, Lu L, Wei LB. SKA3 promotes cell proliferation and migration in cervical cancer by activating the PI3K/Akt signaling pathway. Cancer Cell Int 2018; 18:183. [PMID: 30459531 PMCID: PMC6236911 DOI: 10.1186/s12935-018-0670-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 10/30/2018] [Indexed: 01/03/2023] Open
Abstract
Background Cervical cancer (CC) is one of the most common cancers among females worldwide. Spindle and kinetochore-associated complex subunit 3 (SKA3), located on chromosome 13q, was identified as a novel gene involved in promoting malignant transformation in cancers. However, the function and underlying mechanisms of SKA3 in CC remain unknown. Using the Oncomine database, we found that expression of SKA3 mRNA is higher in CC tissues than in normal tissues and is linked with poor prognosis. Methods In our study, immunohistochemistry showed increased expression of SKA3 in CC tissues. The effect of SKA3 on cell proliferation and migration was evaluated by CCK8, clone formation, Transwell and wound-healing assays in HeLa and SiHa cells with stable SKA3 overexpression and knockdown. In addition, we established a xenograft tumor model in vivo. Results SKA3 overexpression promoted cell proliferation and migration and accelerated tumor growth. We further identified that SKA3 is involved in regulating cell cycle progression and the PI3K/Akt signaling pathway via RNA-sequencing (RNA-Seq) and gene set enrichment analyses. Western blotting results revealed that SKA3 overexpression increased levels of p-Akt, cyclin E2, CDK2, cyclin D1, CDK4, E2F1 and p-Rb in HeLa cells. Additionally, the use of an Akt inhibitor (GSK690693) significantly reversed the cell proliferation capacity induced by SKA3 overexpression in HeLa cells. Conclusions We suggest that SKA3 overexpression contributes to CC cell growth and migration by promoting cell cycle progression and activating the PI3K-Akt signaling pathway, which may provide potential novel therapeutic targets for CC treatment.
Collapse
Affiliation(s)
- Rong Hu
- 1Shenzhen Hospital, Southern Medical University, No. 1333, Xinhu Road, Bao'an District, Shenzhen, 518101 Guangdong China.,2School of Traditional Chinese Medicine, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515 Guangdong China
| | - Ming-Qing Wang
- 1Shenzhen Hospital, Southern Medical University, No. 1333, Xinhu Road, Bao'an District, Shenzhen, 518101 Guangdong China.,2School of Traditional Chinese Medicine, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515 Guangdong China
| | - Wen-Bo Niu
- 5Cancer Research Institute, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515 Guangdong China
| | - Yan-Jing Wang
- 3Zhujiang Hospital of Southern Medical University, No. 253, Industrial Avenue, Haizhu District, Guangzhou, 510280 Guangdong China
| | - Yang-Yang Liu
- Zhongshan Huangpu People's Hospital, No. 32, Long'an Street, Huangpu Town, Zhongshan, 528429 Guangdong China
| | - Ling-Yu Liu
- 1Shenzhen Hospital, Southern Medical University, No. 1333, Xinhu Road, Bao'an District, Shenzhen, 518101 Guangdong China.,2School of Traditional Chinese Medicine, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515 Guangdong China
| | - Ming Wang
- 3Zhujiang Hospital of Southern Medical University, No. 253, Industrial Avenue, Haizhu District, Guangzhou, 510280 Guangdong China
| | - Juan Zhong
- 1Shenzhen Hospital, Southern Medical University, No. 1333, Xinhu Road, Bao'an District, Shenzhen, 518101 Guangdong China.,2School of Traditional Chinese Medicine, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515 Guangdong China
| | - Hai-Yan You
- 1Shenzhen Hospital, Southern Medical University, No. 1333, Xinhu Road, Bao'an District, Shenzhen, 518101 Guangdong China.,2School of Traditional Chinese Medicine, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515 Guangdong China
| | - Xiao-Hui Wu
- 1Shenzhen Hospital, Southern Medical University, No. 1333, Xinhu Road, Bao'an District, Shenzhen, 518101 Guangdong China.,2School of Traditional Chinese Medicine, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515 Guangdong China
| | - Ning Deng
- 2School of Traditional Chinese Medicine, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515 Guangdong China
| | - Lu Lu
- 4The First Affiliated Hospital, Guangzhou University of Chinese Medicine, No.16 Baiyun Airport Road, Baiyun District, Guangzhou, 510405 Guangdong China
| | - Lian-Bo Wei
- 1Shenzhen Hospital, Southern Medical University, No. 1333, Xinhu Road, Bao'an District, Shenzhen, 518101 Guangdong China.,2School of Traditional Chinese Medicine, Southern Medical University, No. 1838, Guangzhou Avenue North, Baiyun District, Guangzhou, 510515 Guangdong China
| |
Collapse
|
32
|
Deborde T, Chatignoux E, Quintin C, Beltzer N, Hamers FF, Rogel A. Breast cancer screening programme participation and socioeconomic deprivation in France. Prev Med 2018; 115:53-60. [PMID: 30099047 DOI: 10.1016/j.ypmed.2018.08.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/18/2018] [Accepted: 08/04/2018] [Indexed: 11/17/2022]
Abstract
The objective was to quantify the relationship between deprivation and national breast cancer screening programme (NBCSP) participation at an ecological level in mainland France. Data from 4,805,390 women-living in 36,209 municipalities within 95 departments-participating in the 2013-2014 NBCSP were analysed using the French Deprivation Index (FDep). FDep population quintiles by municipality were computed to describe NBCSP participation according to deprivation. To better examine the relationship between continuous value of deprivation index and participation rates at the municipality level, we built a generalized linear mixed model. Geographical variations in participation rates were marked. The national standardized participation rate was higher in the intermediate quintiles (55%), 45% for the least deprived one and 52% for the most deprived one. Using our model, we also obtained an inverted U-curve for the relationship between NBCSP participation and municipality deprivation: participation was lower for both the least and most deprived municipalities. This relationship was also observed for each of the two subpopulations-urban municipalities and rural ones-considered separately. Introducing the FDep in the model reduced slightly the unexplained variations in participation rates between departments and between municipalities (with a proportional change in variance of 14% and 12% respectively). We highlight major disparities in departmental participation rates and FDep/participation profiles. However, deprivation appears to have only little influence on geographical variation in participation rates. There is a need to further understand the factors affecting geographical variation in participation rates, in particular the use of opportunistic screening.
Collapse
Affiliation(s)
- Thérèse Deborde
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Edouard Chatignoux
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Cécile Quintin
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Nathalie Beltzer
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Françoise F Hamers
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Agnès Rogel
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France.
| |
Collapse
|
33
|
Pap Testing in a High-Income Country with Suboptimal Compliance Levels: A Survey on Acceptance Factors among Sicilian Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091804. [PMID: 30131461 PMCID: PMC6165068 DOI: 10.3390/ijerph15091804] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 08/14/2018] [Accepted: 08/20/2018] [Indexed: 11/16/2022]
Abstract
Cervical cancer screening is uncommon, especially in low-income countries and among lower socioeconomic status people in high-income countries. The aims of this study were to examine the adherence of Sicilian women to Pap testing and to identify the determinants of this in a population with a secondary prevention attitude lower than high-income countries and the national average. A cross-sectional study called “Save Eva in Sicily” was conducted among all women aged 25–64 years, with a sample drawn by the list of general practitioners (GPs), using a proportional sampling scheme, stratified by age and resident population. The study outcome was performing a Pap test within the past three years. The association between the outcome and Pap test determinants was analyzed through a multivariable logistic regression. Among the 365 interviewed women, 66% (n = 243) had a Pap test during the last 3 years. On the other hand, 18% of the other women (n = 66) had performed at least one Pap test previously and 16% (n = 56) had never had a Pap test. In a multivariable model, GPs’ advice (adjusted OR 2.55; 95% CI 1.57–4.14) and perceived susceptibility (adjusted OR 3.24; 95% CI 1.92–5.48) increased the likelihood of the execution of a Pap test. The “Save Eva in Sicily” study identified GP advice and perceived cancer severity as the main correlates of Pap testing among Sicilian women, producing evidence regarding how policy makers can increase compliance. Interventions to increase Pap test adhesion should focus on stimulating GPs to identify patients who regularly do not undergo it and to recommend testing on a regular basis to their patients.
Collapse
|
34
|
Bao H, Zhang L, Wang L, Zhang M, Zhao Z, Fang L, Cong S, Zhou M, Wang L. Significant variations in the cervical cancer screening rate in China by individual-level and geographical measures of socioeconomic status: a multilevel model analysis of a nationally representative survey dataset. Cancer Med 2018; 7:2089-2100. [PMID: 29573569 PMCID: PMC5943548 DOI: 10.1002/cam4.1321] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 02/06/2023] Open
Abstract
Variations in cervical cancer screening rates in China have rarely been studied in depth. This study aimed to investigate cervical cancer screening rates in relation to both individual‐level and geographical measures of socioeconomic status (SES). Data were obtained from women aged 21 years or older by face‐to‐face interviews between August 2013 and July 2014 as part of the Chinese Chronic Diseases and Risk Factors Surveillance. The geographical variables were obtained from the 2010 Chinese population census. The cervical cancer screening rates and 95% confidence interval (CI) were estimated and mapped. Multilevel logistic regression models were fitted. Overall, only 21.4% (95% CI: 19.6–23.1%) of 91,816 women aged ≥21 years reported having ever been screened for cervical cancer and significant geographical variations at both province and county levels were identified (P < 0.01). The cervical cancer screening rates were the lowest among the poor [13.9% (95% CI: 12.1–15.7%)], uninsured [14.4% (95% CI: 10.3–18.4%)], less‐educated [16.0% (95% CI: 14.3–17.6%)], and agricultural employment [18.1% (95% CI: 15.8–20.4%)] women along with those residing in areas of low economic status [15.0% (95% CI: 11.8–18.2%)], of low urbanization [15.6% (95% CI: 13.4–17.7%)], and of low education status [16.0% (95% CI: 14.0–18.1%)]. The multilevel analysis also indicated that women with lower individual‐level measures of SES residing in areas with low geographical measures of SES were significantly less likely to receive cervical cancer screening (P < 0.0001). Despite the launch of an organized cancer screening program in China, cervical cancer screening rates remain alarmingly low and significant variations based on geographical regions and measures of SES still exist. It is therefore essential to adopt strategies to better direct limited available public resources to priority groups.
Collapse
Affiliation(s)
- Heling Bao
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lei Zhang
- Research Centre for Public Health, Tsinghua University, Beijing, China.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Limin Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mei Zhang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhenping Zhao
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Liwen Fang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shu Cong
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Maigeng Zhou
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Linhong Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| |
Collapse
|
35
|
de Vries E, Arroyave I, Pardo C. Re-emergence of educational inequalities in cervical cancer mortality, Colombia 1998–2015. J Cancer Policy 2018. [DOI: 10.1016/j.jcpo.2017.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
36
|
Petkeviciene J, Ivanauskiene R, Klumbiene J. Sociodemographic and lifestyle determinants of non-attendance for cervical cancer screening in Lithuania, 2006–2014. Public Health 2018; 156:79-86. [DOI: 10.1016/j.puhe.2017.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 11/29/2017] [Accepted: 12/16/2017] [Indexed: 01/21/2023]
|
37
|
Seo JY, Li J, Li K. Cervical Cancer Screening Experiences Among Chinese American Immigrant Women in the United States. J Obstet Gynecol Neonatal Nurs 2018; 47:52-63. [PMID: 29144960 PMCID: PMC6260927 DOI: 10.1016/j.jogn.2017.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To understand the experiences and perceptions of having cervical cancer screening tests and to explore the extant barriers to having the tests among first-generation Chinese American women in the United States. DESIGN Qualitative, descriptive, phenomenological research. SETTING Los Angeles, California. PARTICIPANTS Snowball and purposive sampling of 12 Chinese American immigrant women ages 20 to 65 years. METHODS Individual face-to-face, in-depth, semistructured interviews in which participants were asked about their experiences and perceptions about cervical cancer screening. Interviews were audiotaped, transcribed, and translated into English. Data analysis included comparing and distinguishing, collecting and counting, and presupposing and inferring. RESULTS Through the analysis process, we identified four major themes that reflected the experiences, perceptions, and barriers to having cervical cancer screening among Chinese American women: Belief in a Healthy Lifestyle, Maintaining Privacy for Female Health Problems, Fear of Losing Control, and Feeling Vulnerable in an Unfamiliar Health Care System. These themes indicated that Chinese immigrant women in the United States face challenges to their cultural health beliefs and practices with regard to decision-making and health-seeking behaviors related to cervical cancer screening. They felt more vulnerable as immigrants because of systematic barriers to navigation of the unfamiliar health care system and limited resources. CONCLUSION Women's health care providers should be aware of and give consideration to cultural differences through the provision of more educational information and comfort to Chinese immigrant women who seek cervical cancer screening. Ultimately, the development of culturally appropriate and affordable cancer prevention programs with effective strategies is important to ease Chinese American women's senses of vulnerability.
Collapse
|
38
|
Kelly DM, Estaquio C, Léon C, Arwidson P, Nabi H. Temporal trend in socioeconomic inequalities in the uptake of cancer screening programmes in France between 2005 and 2010: results from the Cancer Barometer surveys. BMJ Open 2017; 7:e016941. [PMID: 29247085 PMCID: PMC5736043 DOI: 10.1136/bmjopen-2017-016941] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Cancer screening is a form of secondary prevention for a disease which is now the leading cause of death in France. Various socioeconomic indicators have been identified as potential factors for disparities in breast, cervical and colorectal cancer screening uptake. We aimed to identify the socioeconomic inequalities, which persisted in screening uptake for these cancers, and to quantify these disparities over a 5-year period. SETTING The Cancer Barometer was a population-based-survey carried out in 2005 and 2010 in France. PARTICIPANTS A randomly selected sample of participants aged 15-85 years (n=3820 in 2005 and n=3727 in 2010) were interviewed on their participation in breast, cervical and colorectal cancer screening-programmes and their socioeconomic profile. PRIMARY AND SECONDARY OUTCOME MEASURES For each type of screening programme, we calculated participation rates, OR and relative inequality indices (RII) for participation, derived from logistic regression of the following socioeconomic variables: income, education, occupation, employment and health insurance. Changes in participation between 2005 and 2010 were then analysed. RESULTS Participation rates for breast and colorectal screening increased significantly among the majority of socioeconomic categories, whereas for cervical cancer screening there were no significant changes between 2005 and 2010. RIIs for income remained significant for cervical smear in 2005 (RII=0.25, 95% CI 0.13 to 0.48) and in 2010 (RII=0.31, 95% CI 0.15 to 0.64). RIIs for education in mammography (RII=0.43, 95% CI 0.19 to 0.98) and cervical smear (RII=0.36, 95% CI 0.21 to 0.64) were significant in 2005 and remained significant for cervical smear (RII=0.40, 95% CI 0.22 to 0.74) in 2010. CONCLUSIONS There was a persistence of socioeconomic inequalities in the uptake of opportunistic cervical cancer screening. Conversely, organised screening programmes for breast and colorectal cancer saw a reduction in relative socioeconomic inequalities, even though the results were not statistically significant. The findings suggest that organised cancer screening programmes may have the potential to reduce socioeconomic disparities in participation.
Collapse
Affiliation(s)
- David Mark Kelly
- Département Recherche en Sciences Humaines et Sociales, Santé Publique, Épidémiologie, Institut National du Cancer, Billancourt, France
| | - Carla Estaquio
- Département Recherche en Sciences Humaines et Sociales, Santé Publique, Épidémiologie, Institut National du Cancer, Billancourt, France
| | | | | | - Hermann Nabi
- Département Recherche en Sciences Humaines et Sociales, Santé Publique, Épidémiologie, Institut National du Cancer, Billancourt, France
- INSERM, Centre for Research in Epidemiology and Population Health, Villejuif, France
- Faculté de Pharmacie, Université Laval, Québec, Canada
- Centre de Recherche du CHU de Québec-Université Laval, Québec, Canada
| |
Collapse
|
39
|
Abstract
INTRODUCTION Understanding the patterns of mammography use and monitoring changes in use are essential to improving national health policy for breast cancer control. We aimed to describe the use of mammography in Portugal and to identify the determinants of its nonuse and underuse by examining data from the National Health Survey 2014. METHODS We analyzed data on 8,758 women aged 30 years or older. We defined women at an eligible age for mammography as women aged 45 to 69. Women who reported a previous mammography test were classified as ever-users and grouped according to time since the most recent test. We computed the prevalence of mammography use, and we used Poisson regression models to obtain age-adjusted and education-adjusted prevalence ratios and 95% confidence intervals. RESULTS The overall prevalence of mammography use was 80.0%, whereas nonuse was 20.0% and underuse 27.3% among users. The prevalence of nonuse and underuse were lower and associations with sociodemographic characteristics, use of health care services, and behavioral factors were stronger among women aged 45 to 69 than among women aged 30 to 44 and women aged 70 or older. The prevalence of mammography use was generally higher in the northern areas of Portugal than in southern areas and varied by marital status, educational level, and household size. A more frequent use of health care services and healthier behaviors were associated with lower prevalences of both nonuse and underuse. CONCLUSION This study illustrates inequalities in mammography use and provides useful information for better allocation of resources in breast cancer screening.
Collapse
Affiliation(s)
- Sofia Chkotua
- Institute of Public Health (ISPUP)-Epidemiology Research Unit (EPI Unit), Universidade do Porto, Porto, Portugal
| | - Bárbara Peleteiro
- Institute of Public Health (ISPUP)-Epidemiology Research Unit (EPI Unit), Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal. .,Departamento de Epidemiologia Clínica, Medicina Preditiva e Saúde Pública, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| |
Collapse
|
40
|
Araujo M, Franck JE, Cadot E, Gautier A, Chauvin P, Rigal L, Ringa V, Menvielle G. Contextual determinants of participation in cervical cancer screening in France, 2010. Cancer Epidemiol 2017; 48:117-123. [PMID: 28482191 DOI: 10.1016/j.canep.2017.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 04/03/2017] [Accepted: 04/25/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Some contextual factors associated with participation in cervical cancer screening are reported in the literature, but few studies have examined their combined effect. Our objective was to assess the role of contextual characteristics, separately and in combination, in participation in cervical cancer screening in France. METHODS Marginal Poisson regression models - taking into account the correlation between women in a given commune - were conducted using data from the Baromètre Santé 2010 survey. The characteristics of the commune of residence of the women studied were the potential spatial accessibility to general practitioners (GP) and gynecologists, the agglomeration category, and the socioeconomic level. RESULTS The analyses were performed in 3380 women, 88.2% of whom were up to date with their cervical cancer screening. Once the individual characteristics were taken into account, the screening participation rate was similar in all the communes, with the exception of those with poor access to a gynecologist and good access to a GP, where the rate was 6% lower (95%CI: 0.5-11%) than in the communes with good access to both GP and gynecologist. The same association with accessibility was observed in small agglomerations. Compared to women living in the more advantaged communes, the screening participation rate was 8% (2-12%) lower in those living in the more disadvantaged ones, except when accessibility to both types of physician was high. DISCUSSION We observed an association between potential spatial accessibility to care in women's residential communities and their cervical cancer screening practices, in particular in small agglomerations, rural communes, and more disadvantaged communes.
Collapse
Affiliation(s)
- Mélanie Araujo
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012 Paris, France.
| | - Jeanna-Eve Franck
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012 Paris, France.
| | | | - Arnaud Gautier
- Santé Publique France, French national public health agency, F-94415 Saint-Maurice, France.
| | - Pierre Chauvin
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012 Paris, France.
| | - Laurent Rigal
- INSERM, Epidemiology and Population Health Research Centre (CESP), U1018, Gender, Sexuality and Health Team, F-94276 Le Kremlin-Bicêtre, France; Univ Paris-Sud, UMRS 1018, F-94276 Le Kremlin-Bicêtre, France; INED, F-75012 Paris, France.
| | - Virginie Ringa
- INSERM, Epidemiology and Population Health Research Centre (CESP), U1018, Gender, Sexuality and Health Team, F-94276 Le Kremlin-Bicêtre, France; Univ Paris-Sud, UMRS 1018, F-94276 Le Kremlin-Bicêtre, France; INED, F-75012 Paris, France.
| | - Gwenn Menvielle
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012 Paris, France.
| |
Collapse
|
41
|
de Groot F, Capri S, Castanier JC, Cunningham D, Flamion B, Flume M, Herholz H, Levin LÅ, Solà-Morales O, Rupprecht CJ, Shalet N, Walker A, Wong O. Ethical Hurdles in the Prioritization of Oncology Care. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:119-126. [PMID: 27766548 PMCID: PMC5343076 DOI: 10.1007/s40258-016-0288-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
With finite resources, healthcare payers must make difficult choices regarding spending and the ethical distribution of funds. Here, we describe some of the ethical issues surrounding inequity in healthcare in nine major European countries, using cancer care as an example. To identify relevant studies, we conducted a systematic literature search. The results of the literature review suggest that although prevention, access to early diagnosis, and radiotherapy are key factors associated with good outcomes in oncology, public and political attention often focusses on the availability of pharmacological treatments. In some countries this focus may divert funding towards cancer drugs, for example through specific cancer drugs funds, leading to reduced expenditure on other areas of cancer care, including prevention, and potentially on other diseases. In addition, as highly effective, expensive agents are developed, the use of value-based approaches may lead to unacceptable impacts on health budgets, leading to a potential need to re-evaluate current cost-effectiveness thresholds. We anticipate that the question of how to fund new therapies equitably will become even more challenging in the future, with the advent of expensive, innovative, breakthrough treatments in other therapeutic areas.
Collapse
Affiliation(s)
- Folkert de Groot
- ToendersdeGroot B.V, Boomstede 281, 3608 AN, Maarssen, The Netherlands.
| | - Stefano Capri
- School of Economics and Management, LIUC University, Castellanza, Italy
| | | | | | | | - Mathias Flume
- Kassenärztliche Vereinigung Westfalen Lippe, Dortmund, Germany
| | | | - Lars-Åke Levin
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | | | | | | | | | |
Collapse
|
42
|
Socioeconomic inequalities to accessing vaccination against human papillomavirus in France: Results of the Health, Health Care and Insurance Survey, 2012. Rev Epidemiol Sante Publique 2017; 65:109-117. [DOI: 10.1016/j.respe.2017.01.100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 01/12/2017] [Accepted: 01/16/2017] [Indexed: 11/19/2022] Open
|
43
|
Dyer G, Larsen SR, Gilroy N, Brice L, Greenwood M, Hertzberg M, Kabir M, Brown L, Hogg M, Huang G, Moore J, Gottlieb D, Kwan J, Tan J, Ward C, Kerridge I. Adherence to cancer screening guidelines in Australian survivors of allogeneic blood and marrow transplantation (BMT). Cancer Med 2016; 5:1702-16. [PMID: 27108674 PMCID: PMC4944898 DOI: 10.1002/cam4.729] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/14/2016] [Accepted: 03/15/2016] [Indexed: 11/07/2022] Open
Abstract
Allogeneic Blood and Marrow Transplant (BMT) survivors are at high risk of secondary cancers. Although current guidelines endorse survivors following Country-specific general population screening recommendations to mitigate this risk, little is known about cancer screening adherence in Australian BMT survivors. We conducted a cross-sectional survey of 441 BMT survivors who were >1 year post transplant, to explore rates of screening for secondary cancers and to identify barriers to cancer screening recommendations. Survey instruments included the Sydney Post-BMT Survey, FACT-BMT, DASS 21, The Chronic Graft versus Host Disease (GVHD) Activity Assessment-Patient Self-Report (Form B), the Lee Chronic GVHD Symptom Scale, Fear of Cancer Recurrence Scale, and The Post Traumatic Growth Inventory. Fifty-seven percent of respondents were male, median age 54 years, and 40% were >6 years post-BMT. Rates of cancer screening adherence were as follows: cervical 63.4%, breast 53.3%, skin 52.4%, and bowel 32.3%. Older BMT survivors and those >2 years post transplant were more likely to undergo cancer screening. Improved quality of life was associated with screening for skin, breast, and cervical cancer. Fear of cancer recurrence negatively impacted on cervical screening. For those who had not undergone screening, the majority reported not being advised to do so by their treatment team. This study is the largest and most comprehensive to date exploring cancer screening adherence in BMT survivors in Australia. These data provide the basis for health service reform to better meet the needs of BMT survivors and provide evidence to support counseling and education of both patients and professionals.
Collapse
Affiliation(s)
- Gemma Dyer
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Stephen R Larsen
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Nicole Gilroy
- Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Lisa Brice
- Department of Haematology, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Matt Greenwood
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Haematology, Royal North Shore Hospital, St. Leonards, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Camperdown, NSW, Australia
| | - Masura Kabir
- Westmead Breast Cancer Institute, Westmead, NSW, Australia
| | - Louisa Brown
- Department of Haematology, Calvary Mater Newcastle, Newcastle, NSW, Australia
| | - Megan Hogg
- Department of Haematoloy, Westmead Hospital, Sydney, NSW, Australia
| | - Gillian Huang
- Department of Haematoloy, Westmead Hospital, Sydney, NSW, Australia
| | - John Moore
- Department of Haematology, St Vincents Hospital, Sydney, NSW, Australia
| | - David Gottlieb
- Department of Haematoloy, Westmead Hospital, Sydney, NSW, Australia
| | - John Kwan
- Department of Haematoloy, Westmead Hospital, Sydney, NSW, Australia
| | - Jeff Tan
- Department of Haematology, St Vincents Hospital, Sydney, NSW, Australia
| | - Christopher Ward
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Haematology, Royal North Shore Hospital, St. Leonards, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Ian Kerridge
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Haematology, Royal North Shore Hospital, St. Leonards, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
44
|
Constantinou P, Dray-Spira R, Menvielle G. Cervical and breast cancer screening participation for women with chronic conditions in France: results from a national health survey. BMC Cancer 2016; 16:255. [PMID: 27029643 PMCID: PMC4815180 DOI: 10.1186/s12885-016-2295-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/23/2016] [Indexed: 01/11/2023] Open
Abstract
Background Comorbidity at the time of diagnosis is an independent prognostic factor for survival among women suffering from cervical or breast cancer. Although cancer screening practices have proven their efficacy for mortality reduction, little is known about adherence to screening recommendations for women suffering from chronic conditions. We investigated the association between eleven chronic conditions and adherence to cervical and breast cancer screening recommendations in France. Method Using data from a cross-sectional national health survey conducted in 2008, we analyzed screening participation taking into account self-reported: inflammatory systemic disease, cancer, cardiovascular disease, chronic respiratory disease, depression, diabetes, dyslipidemia, hypertension, obesity, osteoarthritis and thyroid disorders. We first computed age-standardized screening rates among women who reported each condition. We then estimated the effect of having reported each condition on adherence to screening recommendations in logistic regression models, with adjustment for sociodemographic characteristics, socioeconomic position, health behaviours, healthcare access and healthcare use. Finally, we investigated the association between chronic conditions and opportunistic versus organized breast cancer screening using multinomial logistic regression. Results The analyses were conducted among 4226 women for cervical cancer screening and 2056 women for breast cancer screening. Most conditions studied were not associated with screening participation. Adherence to cervical cancer screening recommendations was higher for cancer survivors (OR = 1.73 [0.98–3.05]) and lower for obese women (OR = 0.73 [0.57–0.93]), when accounting for our complete range of screening determinants. Women reporting chronic respiratory disease or diabetes participated less in cervical cancer screening, except when adjusting for socioeconomic characteristics. Adherence to breast cancer screening recommendations was lower for obese women and women reporting diabetes, even after accounting for our complete range of screening determinants (OR = 0.71 [0.52–0.96] and OR = 0.55 [0.36–0.83] respectively). The lower breast cancer screening participation for obese women was more pronounced for opportunistic than for organized screening. Conclusion We identified conditions associated with participation in cervical and breast cancer screening, even when accounting for major determinants of cancer screening. Obese women participated less in cervical cancer screening. Obese women and women with diabetes participated less in mammographic screening and organized breast cancer screening seemed to insufficiently address barriers to participation. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2295-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Panayotis Constantinou
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France. .,Université Paris-Saclay, Université Paris-Sud, UVSQ, INSERM, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France.
| | - Rosemary Dray-Spira
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France
| | - Gwenn Menvielle
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France
| |
Collapse
|
45
|
Pichetti S, Penneau A, Lengagne P, Sermet C. [Access to care and prevention for people with disabilities in France: Analysis based on data from the 2008 French health and disabilities households surveys (Handicap-Santé-Ménages)]. Rev Epidemiol Sante Publique 2016; 64:79-94. [PMID: 26952841 DOI: 10.1016/j.respe.2015.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 10/01/2015] [Accepted: 11/17/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Using data from the 2008 French health and disabilities households surveys, this study examines the use of three types of routine medical care (dental, ophthalmological and gynecological care) and four preventive services (cervical cancer screening, breast cancer screening, colon cancer screening and vaccination against hepatitis B) both for people with disabilities and for those without. Two definitions of disability were retained: (1) functional limitations (motor, cognitive, visual or hearing limitations) and (2) administrative recognition of disability. METHODS For each type of care, binary logistic regression was used to test whether access to care is influenced by any of the disability indicators as well as by other explanatory variables. Two set of explanatory variables were included successively: (1) sociodemographic variables such as age, gender as well as a proxy variable representing medical needs and (2) socioeconomic variables such as level of education, household income per consumption unit, supplementary health insurance coverage, co-payment exemption and geographic variables. RESULTS Persons reporting functional limitations are less likely to access to all types of care, in a proportion that varies between 5 to 27 points, compared to persons without functional limitations, except for eye care for which no gap is observed. The same results are obtained for persons reporting an administrative recognition of disability, and more precisely for those who benefit from the Disability allowance for adults (Allocation adulte handicapé [AAH]). After adding the social variables to the model, problems of access to health care decrease significantly, showing that disabled persons' social situation tends to reduce their access to care. CONCLUSION This study reveals, for a broad range of care, a negative differential access to care for persons reporting functional limitations compared to those without limitations which is confirmed when identifying disability through administrative recognition. Furthermore, it also discusses factors explaining these differentials. It highlights the role of the social situation of disabled people as an additional barrier to already limited access to healthcare.
Collapse
Affiliation(s)
- S Pichetti
- Irdes, 117 bis, rue Manin, 75019 Paris, France.
| | - A Penneau
- Irdes, 117 bis, rue Manin, 75019 Paris, France
| | - P Lengagne
- Irdes, 117 bis, rue Manin, 75019 Paris, France
| | - C Sermet
- Irdes, 117 bis, rue Manin, 75019 Paris, France
| |
Collapse
|
46
|
Chong VH, Lim AG, Baharudin HN, Tan J, Chong CF. Poor knowledge of colorectal cancer in Brunei Darussalam. Asian Pac J Cancer Prev 2016; 16:3927-30. [PMID: 25987062 DOI: 10.7314/apjcp.2015.16.9.3927] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the most common gastrointestinal cancer and the incidence is increasing in many developing countries. While it can be detected early and even prevented through screening and removal of premalignant lesions, there are barriers to screening which include low level of knowledge and awareness of CRC. This study assessed the level of knowledge of CRC in Brunei Darussalam. MATERIALS AND METHODS A total of 431 (262 male and 161 female) subjects participated in this questionnaire study. Subjects were scored on their knowledge of signs/symptoms (maximum 10 correct answers) and known risk factors for CRC (maximum 10 correct answers) and were categorised into poor (0-2), moderate (3-4) and satisfactory (5-10). Comparisons were made between the various patient factors. RESULTS Overall, 54.1% could not name any CRC signs/symptoms or associated risk factors. Most were not aware of any screening modalities. The overall scores for CRC signs/symptoms and risk factors were 1.3±1.39 (range 0-6) and 0.6±1.05 (range 0-5) respectively. Overall, the breakdown of scores was: poor (78.1%), moderate (20.3%) and satisfactory (6.2%) for signs/symptoms and poor (93.2%), moderate (6.2%) and satisfactory (0.7%) for risk factors. Higher level of education, female gender and non-Malay race were associated with higher scores for both signs/symptoms and knowledge of screening modality; however the overall scores were low. CONCLUSIONS Our study showed that the general knowledge of CRC in Brunei Darussalam is poor. Being female, with higher levels of education and non-Malay race were associated with higher scores, but they were still generally poor. More needs to be done to increase the public knowledge and awareness of CRC.
Collapse
Affiliation(s)
- Vui Heng Chong
- Division of Gastroenterology, Department of Medicine, RIPAS Hospital, Brunei Darussalam E-mail :
| | | | | | | | | |
Collapse
|
47
|
Feng R, Shen X, Chai J, Chen P, Cheng J, Liang H, Zhao T, Sha R, Li K, Wang D. Assessment and model guided cancer screening promotion by village doctors in China: a randomized controlled trial protocol. BMC Cancer 2015; 15:674. [PMID: 26458906 PMCID: PMC4603763 DOI: 10.1186/s12885-015-1688-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 10/07/2015] [Indexed: 11/29/2022] Open
Abstract
Background Proven cost-effectiveness contrasted by low uptake of cancer screening (CS) calls for new methodologies promoting the service. Contemporary interventions in this regard relies primarily on strategies targeting general or specific groups with limited attention being paid to individualized approaches. This trial tests a novel package promoting CS utilization via continuous and tailored counseling delivered by primary caregivers. It aims at demonstrating that high risk individuals in the intervention arm will, compared to those in the delayed intervention condition, show increased use of CS service. Methods/Design The trial adopts a quasi-randomized controlled trial design and involves 2160 high risk individuals selected, via rapid and detailed risk assessments, from about 72,000 farmers aged 35+ in 36 administrative villages randomized into equal intervention and delayed intervention arms. The CS intervention package uses: a) village doctors and village clinics to deliver personalized and thus relatively sophisticated CS counseling; b) two-stage risk assessment models in identifying high risk individuals to focus the intervention on the most needed; c) standardized operation procedures to guide conduct of counseling; d) real-time effectiveness and quality monitoring to leverage continuous improvement; e) web-based electronic system to enable prioritizing complex determinants of CS uptake and tailoring counseling sessions to the changing needs of individual farmers. The intervention arm receives baseline and semiannual follow up evaluations plus CS counseling for 5 years; while the delayed intervention arm, only the same baseline and follow-up evaluations for the first 5 years and CS counseling starting from the 6th year if the intervention proved effective. Evaluation measures include: CS uptake by high risk farmers and changes in their knowledge, perceptions and self-efficacy about CS. Discussion Given the complexity and heterogeneity in the determinant system of individual CS service seeking behavior, personalized interventions may prove to be an effective strategy. The current trial distinguishes itself from previous ones in that it not only adopts a personalized strategy but also introduces a package of pragmatic solutions based on proven theories for tackling potential barriers and incorporating key success factors in a synergetic way toward low cost, effective and sustainable CS promotion. Trial registration ISRCTN33269053 Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1688-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Rui Feng
- Department of Literature Review and Analysis, Library of Anhui Medical University, Hefei, Anhui, China.
| | - Xingrong Shen
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Jing Chai
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Penglai Chen
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Jing Cheng
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Han Liang
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Ting Zhao
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Rui Sha
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Kaichun Li
- Luan Center for Disease Control and Prevention, Luan, Anhui, China.
| | - Debin Wang
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China. .,Collaboration Center for Cancer Control, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
| |
Collapse
|