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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.
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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
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Duchange N, Poiseuil M, Rollet Q, Piette C, Cosson M, Quertier MC, Moutel G, Darquy S. How do women comply with cancer screenings? A study in four regions of France. BMC Womens Health 2023; 23:190. [PMID: 37085818 PMCID: PMC10122322 DOI: 10.1186/s12905-023-02311-5] [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: 11/04/2021] [Accepted: 03/27/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND This article looks at the behaviour of women facing different cancer screening options available to them from the age of 50 onward. The study was conducted in 2019 in four departments of the French territory with the objective of identifying the factors that influence acceptance of a population-based screening proposal. METHODS A questionnaire was sent to women who had received three invitations to organised screenings (OS) for both breast and colorectal cancer. The categories of participants in both OS were designed from data from the regional cancer screening coordination centres in each department. Participation in opportunistic cervical cancer screening was evaluated as self-reported data. RESULTS 4,634 questionnaires were returned out of the 17,194 sent, giving a global return rate of 27%. The highest rate of return (73.5%) was obtained from women who had participated at least once in both breast and colorectal cancer OS. An intermediate rate was obtained from women participating in breast cancer OS only (18.7%). Poor levels of return came from women who had participated in colorectal cancer OS only (3.6%) and from non-participants (4.1%). Our results suggest that women with lower educational levels tend to be the most regular attendants at OS (50.3%), compared to highly educated women (39.7%). 11.8% of women were overdue in their opportunistic cervical cancer screening. This percentage rose to 35.4% in the category of non-participants. In addition, women's comments provide a better understanding of the reasons for irregular attendance and non-participation. CONCLUSION Overall, similar behaviours towards screening were observed in the four departments. Our analysis suggests that participation in one cancer OS increases the likelihood of participating in others. This adhesion could be an interesting lever for raising women's awareness of other cancer screenings.
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Affiliation(s)
- Nathalie Duchange
- Normandie univ, UNICAEN, Inserm U1086, ANTICIPE, Caen, 14000, France
| | - Marie Poiseuil
- Cancer et expositions environnementales, Univ. Bordeaux, Inserm U1219, EPICENE, Bordeaux, 33000, France
| | - Quentin Rollet
- Normandie univ, UNICAEN, Inserm U1086, ANTICIPE, Caen, 14000, France
| | - Christine Piette
- Centre Régional de Coordination du Dépistage des Cancers (CRCDC), Bretagne, France
| | - Mathilde Cosson
- Centre Régional de Coordination du Dépistage des Cancers (CRCDC), Bretagne, France
| | | | - Grégoire Moutel
- Normandie univ, UNICAEN, Inserm U1086, ANTICIPE, Caen, 14000, France
| | - Sylviane Darquy
- Cancer et expositions environnementales, Univ. Bordeaux, Inserm U1219, EPICENE, Bordeaux, 33000, France.
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Prajapati N, Soler-Michel P, Vieira VM, Padilla CM. Role of mammography accessibility, deprivation and spatial effect in breast cancer screening participation in France: an observational ecological study. Int J Health Geogr 2022; 21:21. [PMID: 36566241 PMCID: PMC9789573 DOI: 10.1186/s12942-022-00320-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 12/07/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The detection of cancer in its early latent stages can improve patients' chances of recovery and thereby reduce the overall burden of the disease. Our objectives were to investigate factors (geographic accessibility and deprivation level) affecting mammography screening participation variation and to determine how much geographic variation in participation rates can be explained by spillover effects between adjacent areas, while controlling for covariates. METHODS Mammography screening participation rates between 2015 and 2016 were calculated by census blocks (CB), for women aged 50-74 years, residing in Lyon metropolitan area. Global spatial autocorrelation tests were applied to identify the geographic variation of participation. Spatial regression models were used to incorporate spatial structure to estimate associations between mammography participation rate and the combined effect (geographic accessibility and deprivation level) adjusting for modes of travel and social cohesion. RESULTS The mammography participation rate was found to have a statistically significant and positive spatial correlation. The participation rate of one CB was significantly and positively associated with the participation rates of neighbouring CB. The participation was 53.2% in residential and rural areas and 46.6% in urban areas, p < 0.001. Using Spatial Lag models, whereas the population living in most deprived CBs have statistically significantly lower mammography participation rates than lower deprived ones, significant interaction demonstrates that the relation differs according to the degree of urbanization. CONCLUSIONS This study makes an important methodological contribution in measuring geographical access and understanding better the combined effect of deprivation and the degree of urbanization on mammography participation and other contextual factors that affect the decision of using mammography screening services -which is a critical component of healthcare planning and equity.
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Affiliation(s)
- Nirmala Prajapati
- grid.410368.80000 0001 2191 9284Univ Rennes, EHESP, CNRS, Inserm, Arènes-UMR 6051, RSMS-U 1309, 35000 Rennes, France
| | - Patricia Soler-Michel
- Centre Régional de Coordination des Dépistages des Cancers Auvergne Rhône Alpes, Lyon, France
| | - Verónica M. Vieira
- grid.266093.80000 0001 0668 7243Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA USA
| | - Cindy M. Padilla
- grid.410368.80000 0001 2191 9284Univ Rennes, EHESP, CNRS, Inserm, Arènes-UMR 6051, RSMS-U 1309, 35000 Rennes, France
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Quersin F, Serman F, Favre J, Rochoy M, Descamps A, Gers E, Duhamel A, Collins C, Deken-Delannoy V, Berkhout C, Raginel T. Participation rate in cervical cancer screening in general practice related to the proximity of gynecology care facilities: A 3 year follow-up cohort study. Front Public Health 2022; 10:955559. [PMID: 36324473 PMCID: PMC9618859 DOI: 10.3389/fpubh.2022.955559] [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: 05/28/2022] [Accepted: 09/21/2022] [Indexed: 01/24/2023] Open
Abstract
Cervical cancer screening (CCS) by Pap tests is mainly performed by gynecologists in France, but also by general practitioners (GPs) and midwives. The screening uptake is insufficient to reduce the incidence of cervical neoplasms. Our aim was to investigate the association between screening rates in patients listed with GPs and the distance between GPs' offices and gynecology facilities. The population of 345 GPs, and their 93,918 female patients eligible for screening over 3 years (2013-2015), were derived from the Health Insurance claim database. We estimated the socioeconomic level of the geographical area of GPs' offices using the European Deprivation Index (EDI). The proximity of gynecology facilities was calculated by computing their distance from GPs' offices (in order to adjust the proximity of gynecology facilities with EDI and performance of smears by the GP). The number of gynecologists within 5 km of a GP's office was associated with the CCS rate increasing by 0.31% for every unit increase in the density of gynecologists within 5 km (p < 0.0001). The close proximity of gynecology facilities was not significantly associated with screening uptake among female patients when the office of the GP where they were registered was settled in a deprived area.
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Affiliation(s)
- François Quersin
- Department of General Practice/Family Medicine, University of Lille, Lille, France
| | - Fanny Serman
- Department of General Practice/Family Medicine, University of Lille, Lille, France
| | - Jonathan Favre
- Department of General Practice/Family Medicine, University of Lille, Lille, France
| | - Michaël Rochoy
- Department of General Practice/Family Medicine, University of Lille, Lille, France
| | - Axel Descamps
- Department of General Practice/Family Medicine, University of Lille, Lille, France
| | - Elise Gers
- University of Lille, CHU Lille, Intern Promotion Division of the Research and Innovation Board, Lille, France
| | - Alain Duhamel
- University of Lille, CHU Lille, EA 2694 – Public Health: Epidemiology and Quality of Care, Lille, France
| | | | - Valérie Deken-Delannoy
- University of Lille, CHU Lille, Service de Statistique, Evaluation Economique, Data-Management, Lille, France
| | - Christophe Berkhout
- Department of General Practice/Family Medicine, University of Lille, Lille, France,Department of Primary Health and Interprofessional Care, University of Antwerp, Antwerp, Belgium,*Correspondence: Christophe Berkhout
| | - Thibaut Raginel
- Normandy University, UniCaen, Inserm U 1086 “Anticipe”, Caen, France,Normandy University, UniCaen, Faculty of Health, Department of General Practice, Caen, France
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Ouanhnon L, Rougé Bugat ME, Lamy S, Druel V, Delpierre C, Grosclaude P. Social and territorial inequalities in breast and cervical cancers screening uptake: a cross-sectional study in France. BMJ Open 2022; 12:e055363. [PMID: 35193917 PMCID: PMC8867371 DOI: 10.1136/bmjopen-2021-055363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/04/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The objective of this cross-sectional study was to investigate the impact of socio-territorial characteristics on mammography and pap smear uptake according to the place of residence in the recommended age groups, and second outside the recommended age groups. SETTING AND PARTICIPANTS We used an existing dataset of 1 027 039 women which combines data from the Health Insurance information systems, with census data from Midi-Pyrénées, France. PRIMARY AND SECONDARY OUTCOME MEASURES Our outcome was, for each woman, the uptake of the pap smear and the uptake of the mammography during the year. RESULTS A social gradient of screening uptake was found in the recommended age groups. This gradient was stronger in large urban areas:(1) For mammography: decile 10 (the most deprived) vs 1 (the least deprived), adjusted OR 0.777, 95% CI (0.748 to 0.808) in large urban area; adjusted OR= 0.808 for decile 1 to 0.726 for decile 10 in other areas vs decile 1 in urban areas;(2) For pap smear: decile 10 vs 1 adjusted OR 0.66, 95%CI (0.642 to 0.679) in large urban areas; adjusted OR= 0.747 for decile 1 to 0.562 for decile 10 in other areas vs decile 1 in urban areas).Screening rates were globally higher in large urban areas.For mammography, the social and territorial disparities were higher outside the recommended age group. CONCLUSIONS Offering a universal approach to every woman, as it is often the case in nationally organised screening programmes, is likely to be insufficient to ensure real equity in access. Developing global dataset combining health data and diverse socioeconomic data, at individual and contextual levels, could enable a better understanding of the mechanisms involved in this social gradient, and therefore, the development of targeted territorial actions to improve equity of access to healthcare.
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Affiliation(s)
- Lisa Ouanhnon
- DUMG (Département Universitaire de Médecine Générale), Université Toulouse III Paul Sabatier, Toulouse, France
- CERPOP, INSERM UMR_S 1027, Toulouse, France
| | - Marie-Eve Rougé Bugat
- DUMG (Département Universitaire de Médecine Générale), Université Toulouse III Paul Sabatier, Toulouse, France
- CERPOP, INSERM UMR_S 1027, Toulouse, France
| | - Sebastien Lamy
- CERPOP, INSERM UMR_S 1027, Toulouse, France
- Registre des cancers du Tarn, Institute Claudius Regaud, Toulouse, France
| | - Vladimir Druel
- DUMG (Département Universitaire de Médecine Générale), Université Toulouse III Paul Sabatier, Toulouse, France
- CERPOP, INSERM UMR_S 1027, Toulouse, France
| | - Cyrille Delpierre
- CERPOP, INSERM UMR_S 1027, Toulouse, France
- LEASP, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Pascale Grosclaude
- CERPOP, INSERM UMR_S 1027, Toulouse, France
- Registre des cancers du Tarn, Institute Claudius Regaud, Toulouse, France
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Al Masry Z, Bazzaro F, Cabaret K, Dembinski O, Devalland C, Gay C, Rey B, Simoncini N, Triclot M, Zerhouni N. [Early detection of breast cancer: study of the socio-technical impact of an "intelligent" bra]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2021; Vol. 33:473-482. [PMID: 35485104 DOI: 10.3917/spub.214.0473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The SBra (Smart Bra) project aims to develop an intelligent bra, combining sensors for measuring skin temperature and the electrical impedance of breast tissue, which could be used for breast cancer screening. The objective of this study is to anticipate both the hindrances to usage and acceptability of SBra with respect to the breast cancer screening practices of healthcare professionals and patients, and then to propose ways to modify the shape and functions of the device to facilitate its potential insertion into the healthcare system. METHODS A qualitative survey was conducted between September 2019 and December 2020, consisting of a series of interviews conducted with hospital and private healthcare professionals (N = 22) working in Burgundy-Franche-Comté and related to breast cancer, and with women aged 38 to 74 years old living in Burgundy-Franche-Comté and Auvergne-Rhône-Alpes (N = 21) who have or have not had breast cancer, and who either practice or refuse screening. RESULTS If patients say they are ready to use such a device, at most once a year, and subject to its usability, the majority of them prefer an examination in the office, performed by a gynecologist or a general practitioner. Health professionals point out that this option generates institutional (remuneration and cost of the procedure) and organizational needs, which are both material and human. DISCUSSION The study highlights the need to pluralize the system in order to respond to the multiplicity of local situations.
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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.
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Affiliation(s)
| | | | | | - Morgan Rouprêt
- Sorbonne Université, GRC n°5, Oncotype-URO, Assistance Publique - Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, 75 013, Paris, France
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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.
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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
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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.
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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
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10
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Franck JE, Ringa V, Rigal L, Sassenou J, Cœuret-Pellicer M, Chauvin P, Menvielle G. Patterns of gynaecological check-up and their association with body mass index within the CONSTANCES cohort. J Med Screen 2020; 28:10-17. [PMID: 32279590 DOI: 10.1177/0969141320914323] [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: 01/19/2023]
Abstract
OBJECTIVES To investigate the relationship between patterns of gynaecological check-up and body mass index while accounting for various determinants of health care use. METHODS Sequence analysis and clustering were used to highlight patterns of gynaecological check-up, which included the regularity of breast and cervical cancer screening and visits to the gynaecologist over four years, among 6182 women aged 54-65 included in the CONSTANCES cohort between 2013 and 2015 in France. Multinomial logistic regressions were used to study the association between these patterns and women's body mass index. RESULTS We identified four patterns of gynaecological check-up, from (A) no or inappropriate check-up (20%) to (D) almost one visit to the gynaecologist every year, overscreening for cervical cancer and frequent use of opportunistic breast cancer screening (12%). From patterns A to D, the proportion of obese women decreased and that of women with normal body mass index increased. Obese and overweight women underwent more breast than cervical cancer screening and were less often overscreened than normal weight women. These differences were only partly explained by the lower socioeconomic situation of overweight and obese women. Beyond the financial barrier, the screening modality and the type of exam may play a role. Among women who were screened for cervical cancer, obese and overweight women were less often screened by a gynaecologist. CONCLUSION Further efforts should be made to enhance the take-up of screening among obese women who are deterred by the healthcare system.
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Affiliation(s)
- Jeanna-Eve Franck
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Virginie Ringa
- CESP Centre for Research in Epidemiology and Population Health, Gender, Sexuality and Health team, University of Paris-Saclay, University of Paris-Sud, UVSQ, Villejuif, France. Ined, Paris, France
| | - Laurent Rigal
- CESP Centre for Research in Epidemiology and Population Health, 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, Gender, Sexuality and Health team, University of Paris-Saclay, University of Paris-Sud, UVSQ, Villejuif, France. Ined, Paris, France
| | - Mireille Cœuret-Pellicer
- Inserm-Versailles Saint Quentin en Yvelines University, "Epidemiological Population-Based Cohorts Unit", Villejuif, France
| | - Pierre Chauvin
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Gwenn Menvielle
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
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11
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Dawidowicz S, Le Breton J, Moscova L, Renard V, Bercier S, Brixi Z, Audureau E, Clerc P, Bastuji-Garin S, Ferrat E. Predictive factors for non-participation or partial participation in breast, cervical and colorectal cancer screening programmes†. Fam Pract 2020; 37:15-24. [PMID: 31305884 DOI: 10.1093/fampra/cmz031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND No study has investigated factors associated with non-participation or partial participation in the different combination patterns of screening programmes for all three cancers, that is, breast, colorectal and cervical cancer. METHODS In a retrospective cohort study, we sought to describe combinations of cancer screening participation rates among women in the Val-de-Marne area of France and to identify individual and contextual factors associated with non-participation or partial participation. RESULTS Women aged between 50 and 65 and who were eligible for all three screening programmes (n = 102 219) were analysed in multilevel logistic models, with the individual as the Level 1 variable and the place of residence as the Level 2 variable. The women who did not participate in any of the screening programmes were 34.4%, whereas 30.1%, 24% and 11.5% participated in one, two or all three screening programmes, respectively. Age below 55, a previous false-positive mammography, prior opportunistic mammography only, no previous mammography, membership of certain health insurance schemes (all P < 0.05) and residence in a deprived area (P < 0.001) were independently associated with non-participation or partial participation. We observed a stronger effect of deprivation on non-participation in all three cancers than in combinations of screening programmes. CONCLUSION Our findings suggest that the health authorities should focus on improving cancer screenings in general rather than screenings for specific types of cancer, especially among younger women and those living in the most socially deprived areas.
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Affiliation(s)
- Sébastien Dawidowicz
- Primary Care Department, School of Medicine, Université Paris-Est Créteil (UPEC), Créteil, France.,Maison de Santé Pluri-professionnelle de Sucy-en-Brie, Sucy-en-Brie, France
| | - Julien Le Breton
- Primary Care Department, School of Medicine, Université Paris-Est Créteil (UPEC), Créteil, France.,DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Laura Moscova
- Primary Care Department, School of Medicine, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Vincent Renard
- Primary Care Department, School of Medicine, Université Paris-Est Créteil (UPEC), Créteil, France.,DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Sandrine Bercier
- Primary Care Department, School of Medicine, Université Paris-Est Créteil (UPEC), Créteil, France.,Association de Dépistage Organisé des Cancers dans le Val-de-Marne, ADOC, Joinville-le-Pont, France
| | - Zahida Brixi
- Association de Dépistage Organisé des Cancers dans le Val-de-Marne, ADOC, Joinville-le-Pont, France
| | - Etienne Audureau
- DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Université Paris-Est Créteil (UPEC), Créteil, France.,Department of Public Health, Assistance Publique Hôpitaux de Paris (APHP), Henri Mondor Hospital, Créteil, France
| | - Pascal Clerc
- DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Université Paris-Est Créteil (UPEC), Créteil, France.,Primary Care Department, School of Medicine, Université de Versailles, Versailles, France
| | - Sylvie Bastuji-Garin
- DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Université Paris-Est Créteil (UPEC), Créteil, France.,Department of Public Health, Assistance Publique Hôpitaux de Paris (APHP), Henri Mondor Hospital, Créteil, France
| | - Emilie Ferrat
- Primary Care Department, School of Medicine, Université Paris-Est Créteil (UPEC), Créteil, France.,DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Université Paris-Est Créteil (UPEC), Créteil, France
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12
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The determinants of cervical cancer screening uptake in women with obesity: application of the Andersen's behavioral model to the CONSTANCES survey. Cancer Causes Control 2019; 31:51-62. [PMID: 31797124 DOI: 10.1007/s10552-019-01251-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Despite their higher risk for and mortality from cervical cancer, evidence indicates low rates of cervical cancer screening (CCS) among women with obesity. The literature on the specific factors related to CCS nonadherence in this population is limited. METHODS We examined the data on 2,934 women with obesity included in the CONSTANCES survey from 2012 to 2015. Using the Andersen's behavioral model, we studied the relationships between the socioeconomic, sociodemographic, health, health personal behaviors, and healthcare use-related factors with CCS nonadherence. The analysis was performed using structural equation models. RESULTS Regular follow-up by a gynecologist, good quality of primary care follow-up, and comorbidities were negatively associated with CCS nonadherence. Limited literacy, older age, being single, living without children, and financial strain were positively associated with CCS nonadherence. Our results do not point to competitive care, since women with comorbidities had better CCS behaviors, which were explained by a good quality of primary care follow-up. CONCLUSION Our study identified the factors that explain CCS nonadherence among women with obesity and clarified the effects of health status and healthcare use on screening. Further efforts should be undertaken to reduce the obstacles to CCS by improving care among women with obesity.
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13
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Maj C, Poncet L, Panjo H, Gautier A, Chauvin P, Menvielle G, Cadot E, Ringa V, Rigal L. General practitioners who never perform Pap smear: the medical offer and the socio-economic context around their office could limit their involvement in cervical cancer screening. BMC FAMILY PRACTICE 2019; 20:114. [PMID: 31416425 PMCID: PMC6694570 DOI: 10.1186/s12875-019-1004-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/31/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND In France, with the growing scarcity of gynecologists and a globally low and socially differentiated coverage of cervical cancer screening (CCS), general practitioners (GPs) are valuable resources to improve screening services for women. Still all GPs do not perform Pap smears. In order to promote this screening among GPs, the characteristics of physicians who never perform CCS should be more precisely specified. Besides already-known individual characteristics, the contextual aspects of the physicians' office, such as gynecologist density in the area, could shape GPs gynecological activities. METHODS To analyze county (département) characteristics of GPs' office associated with no performance of CCS, we used a representative sample of 1063 French GPs conducted in 2009 and we constructed mixed models with two levels, GP and county. RESULTS Almost 35% (n = 369) of the GPs declared never performing CCS. GPs working in counties with a poor GP-density per inhabitants were more likely to perform CCS (odds ratio (OR) = 0.52 for each increase of density by 1 GP per 10,000 inhabitants, 95% confidence interval (CI) = 0.37-0.74). On the contrary, GPs working in counties with an easier access to a gynecologist were more likely not to perform CCS (OR = 1.06 for each increase of density by 1 gynecologist per 100,000 women, 95%CI = 1.03-1.10 and OR = 2.02 if the first gynecologist is reachable in less than 15 min, 95%CI = 1.20-3.41) as well as GPs working in areas with a poverty rate above the national average (OR = 1.66, 95%CI = 1.09-2.54). These contextual characteristics explain most of the differences between counties concerning rates of not performing CCS. CONCLUSIONS Specific programs should be developed for GPs working in contexts unfavorable to their involvement in CCS.
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Affiliation(s)
- Chiara Maj
- General Practice Department, Univ Paris-Sud, Le Kremlin Bicêtre, France
| | - Lorraine Poncet
- CESP (Centre for Research in Epidemiology and Population Health), Inserm U1018, University of Paris-Saclay, University of Paris-Sud, UVSQ, Gender, Sexual and Reproductive Health Team, Paris, France
- Ined, Paris, France
| | - Henri Panjo
- CESP (Centre for Research in Epidemiology and Population Health), Inserm U1018, University of Paris-Saclay, University of Paris-Sud, UVSQ, Gender, Sexual and Reproductive Health Team, Paris, France
- Ined, Paris, France
| | | | - Pierre Chauvin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Department of Social Epidemiology, Paris, F75012, France
| | - Gwenn Menvielle
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Department of Social Epidemiology, Paris, F75012, France
| | - Emmanuelle Cadot
- IRD - Hydrosciences UMR 5569, Montpellier University, Montpellier, F-34090, France
| | - Virginie Ringa
- CESP (Centre for Research in Epidemiology and Population Health), Inserm U1018, University of Paris-Saclay, University of Paris-Sud, UVSQ, Gender, Sexual and Reproductive Health Team, Paris, France
- Ined, Paris, France
| | - Laurent Rigal
- General Practice Department, Univ Paris-Sud, Le Kremlin Bicêtre, France.
- CESP (Centre for Research in Epidemiology and Population Health), Inserm U1018, University of Paris-Saclay, University of Paris-Sud, UVSQ, Gender, Sexual and Reproductive Health Team, Paris, France.
- Ined, Paris, France.
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Bertaut A, Coudert J, Bengrine L, Dancourt V, Binquet C, Douvier S. Does mammogram attendance influence participation in cervical and colorectal cancer screening? A prospective study among 1856 French women. PLoS One 2018; 13:e0198939. [PMID: 29927995 PMCID: PMC6013094 DOI: 10.1371/journal.pone.0198939] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 05/29/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND We aimed to determine participation rates and factors associated with participation in colorectal (fecal occul blood test) and cervical cancer (Pap-smear) screening among a population of women participating in breast cancer screening. METHODS From August to October 2015, a self-administered questionnaire was sent by post to 2 900 women aged 50-65, living in Côte-d'Or, France, and who were up to date with mammogram screening. Polytomic logistic regression was used to identify correlates of participation in both cervical and colorectal cancer screenings. Participation in all 3 screenings was chosen as the reference. RESULTS Study participation rate was 66.3% (n = 1856). Besides being compliant with mammogram, respectively 78.3% and 56.6% of respondents were up to date for cervical and colorectal cancer screenings, while 46.2% were compliant with the 3 screenings. Consultation with a gynecologist in the past year was associated with higher chance of undergoing the 3 screenings or female cancer screenings (p<10-4), when consultation with a GP was associated with higher chance of undergoing the 3 screenings or organized cancer screenings (p<0.05). Unemployment, obesity, age>59 and yearly flu vaccine were associated with a lower involvement in cervical cancer screening. Women from high socio-economic classes were more likely to attend only female cancer screenings (p = 0.009). Finally, a low level of physical activity and tobacco use were associated with higher risk of no additional screening participation (p<10-3 and p = 0.027). CONCLUSIONS Among women participating in breast screening, colorectal and cervical cancer screening rates could be improved. Including communication about these 2 cancer screenings in the mammogram invitation could be worth to explore.
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Affiliation(s)
- Aurélie Bertaut
- Methodology and Biostatistics Unit, Centre Georges François Leclerc, Dijon, France
- * E-mail:
| | - Julien Coudert
- Medical Oncology Unit, Centre Georges François Leclerc, Dijon, France
| | - Leila Bengrine
- Medical Oncology Unit, Centre Georges François Leclerc, Dijon, France
| | - Vincent Dancourt
- ADECA 21-58, « Association pour le dépistage des cancers Côte-d’Or », Dijon, France
| | - Christine Binquet
- INSERM U1231-EPICAD Team, Burgundy-Franche Comte University, Dijon, France
- INSERM CIC1432, University Hospital, Dijon, France
| | - Serge Douvier
- Department of Gynecologic and Oncologic Surgery, University Hospital, Dijon, France
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15
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Belot A, Remontet L, Rachet B, Dejardin O, Charvat H, Bara S, Guizard AV, Roche L, Launoy G, Bossard N. Describing the association between socioeconomic inequalities and cancer survival: methodological guidelines and illustration with population-based data. Clin Epidemiol 2018; 10:561-573. [PMID: 29844706 PMCID: PMC5961638 DOI: 10.2147/clep.s150848] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Describing the relationship between socioeconomic inequalities and cancer survival is important but methodologically challenging. We propose guidelines for addressing these challenges and illustrate their implementation on French population-based data. METHODS We analyzed 17 cancers. Socioeconomic deprivation was measured by an ecological measure, the European Deprivation Index (EDI). The Excess Mortality Hazard (EMH), ie, the mortality hazard among cancer patients after accounting for other causes of death, was modeled using a flexible parametric model, allowing for nonlinear and/or time-dependent association between the EDI and the EMH. The model included a cluster-specific random effect to deal with the hierarchical structure of the data. RESULTS We reported the conventional age-standardized net survival (ASNS) and described the changes of the EMH over the time since diagnosis at different levels of deprivation. We illustrated nonlinear and/or time-dependent associations between the EDI and the EMH by plotting the excess hazard ratio according to EDI values at different times after diagnosis. The median excess hazard ratio quantified the general contextual effect. Lip-oral cavity-pharynx cancer in men showed the widest deprivation gap, with 5-year ASNS at 41% and 29% for deprivation quintiles 1 and 5, respectively, and we found a nonlinear association between the EDI and the EMH. The EDI accounted for a substantial part of the general contextual effect on the EMH. The association between the EDI and the EMH was time dependent in stomach and pancreas cancers in men and in cervix cancer. CONCLUSION The methodological guidelines proved efficient in describing the way socioeconomic inequalities influence cancer survival. Their use would allow comparisons between different health care systems.
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Affiliation(s)
- 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
- Non-Communicable Diseases and Trauma Direction, The French Public Health Agency, Saint-Maurice, France
- Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France
| | - Laurent Remontet
- Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France
- UMR 5558, Biometry and Evolutionary Biology Laboratory, Biostatistics Health Group, CNRS, University Lyon 1, Lyon, France
| | - Bernard Rachet
- 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
| | - Olivier Dejardin
- National Institute of Health and Medical Research U1086 ANTICIPE, Caen, France
- Calvados Digestive Cancer Registry, Centre Hospitalier Universitaire, Caen, France
| | - Hadrien Charvat
- Prevention Division, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Simona Bara
- Manche General Cancer Registry, Centre Hospitalier Public du Cotentin, Cherbourg-en-Cotentin, France
| | - Anne-Valérie Guizard
- National Institute of Health and Medical Research U1086 ANTICIPE, Caen, France
- Calvados General Cancer Registry, Centre François Baclesse, Caen, France
| | - Laurent Roche
- Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France
- UMR 5558, Biometry and Evolutionary Biology Laboratory, Biostatistics Health Group, CNRS, University Lyon 1, Lyon, France
| | - Guy Launoy
- National Institute of Health and Medical Research U1086 ANTICIPE, Caen, France
- Calvados Digestive Cancer Registry, Centre Hospitalier Universitaire, Caen, France
| | - Nadine Bossard
- Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France
- UMR 5558, Biometry and Evolutionary Biology Laboratory, Biostatistics Health Group, CNRS, University Lyon 1, Lyon, France
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16
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Favre J, Rochoy M, Raginel T, Pelletier M, Messaadi N, Deken-Delannoy V, Duhamel A, Berkhout C. The Effect of Cervical Smears Performed by General Practitioners on the Cervical Cancer Screening Rate of their Female Patients: A Claim Database Analysis and Cross-Sectional Survey. J Womens Health (Larchmt) 2018; 27:933-938. [PMID: 29583084 DOI: 10.1089/jwh.2017.6656] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Cervical cancer screening reduces the incidence and specific mortality rate of cervical neoplasms. In most cases screening by means of Pap smears is performed in France by gynecologists. The primary objective of this study was to confirm whether the participation rate is increased when general practitioners (GPs) carry out the smears themselves. The secondary objective was to evaluate other independent characteristics of GPs predicting participation rates in women. METHODS The population of 347 GPs, including their relevant characteristics and their 90,094 female patients eligible for screening over 2 years (2013-2014), was derived from the SIAM claim database of the Flanders Healthcare Insurance Fund (CPAM). A telephone survey among all GPs was carried out to know whether they were performing smears in their surgeries. RESULTS A total of 343 GPs were included for analysis (98.8% participation rate). The mean cervical cancer screening participation rate over 2 years among all the women in the recommended age group (25-65 years) was 43.3% (±6.9). Bivariate analysis showed that participation rate was higher when the GP performed smears (adjusted difference of mean: 2.06 [95% CI: 0.67-3.45], p = 0.037) and whether the GP was female (2.08 [0.42-3.74], p = 0.0144). After multivariate analysis the only significant characteristic of the GP was the performance of smears (1.71 [0.27-3.16], p = 0.0204). CONCLUSIONS Cervical smears performed by GPs led to increased screening participation rates within the recommended age group of women. However, the size of this increase is insufficient to reach the expected participation rates.
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Affiliation(s)
- Jonathan Favre
- 1 Department of General Practice/Family Medicine, School of Medicine, Lille University , Lille, France
| | - Michaël Rochoy
- 1 Department of General Practice/Family Medicine, School of Medicine, Lille University , Lille, France
| | - Thibaut Raginel
- 2 Normandie Univ, UCBN, INSERM U1086, Cancers & Preventions , CHU de Caen, Caen, France .,3 Department of General Medicine, UCBN, Medical School , Normandie Univ, Caen, France
| | - Marine Pelletier
- 1 Department of General Practice/Family Medicine, School of Medicine, Lille University , Lille, France
| | - Nassir Messaadi
- 1 Department of General Practice/Family Medicine, School of Medicine, Lille University , Lille, France
| | - Valérie Deken-Delannoy
- 4 Department of Public Health, Lille Univ. EA 2694, University Hospital Lille , Lille, France
| | - Alain Duhamel
- 4 Department of Public Health, Lille Univ. EA 2694, University Hospital Lille , Lille, France
| | - Christophe Berkhout
- 1 Department of General Practice/Family Medicine, School of Medicine, Lille University , Lille, France
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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.
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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
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18
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Cervical cancer screening among Lebanese women. Rev Epidemiol Sante Publique 2017; 66:1-6. [PMID: 29249573 DOI: 10.1016/j.respe.2017.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 09/06/2017] [Accepted: 10/03/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cervical cancer is a very common malignancy amongst women worldwide. Pap smear is an effective and inexpensive screening test in asymptomatic women. The aim of this paper was to assess the prevalence of Pap smear screening for cervical cancer among Lebanese women and to determine associated sociodemographic and psychosocial characteristics. METHODS This national survey included 2255 women, selected by multi-stage random cluster sampling across Lebanon. A questionnaire about practices and perceptions related to cervical cancer screening was developed based on the "Health Belief Model". RESULTS The weighted national prevalence of "ever-use" of the Pap smear for screening purposes was 35%. Most important determinants of screening behavior were: residence within Greater Beirut, higher socio-economic status and educational attainment, marriage status, presence of a health coverage, awareness of Pap smear usefulness, knowing someone who had already done it, and a balance between perceived benefits and perceived barriers to Pap smear screening. CONCLUSION Regular information campaigns regarding the availability and effectiveness of the test should be devised, targeting in priority the sexually vulnerable women in Lebanon. Moreover, healthcare providers should be encouraged to discuss with their patients the opportunity of obtaining a Pap smear.
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Rochoy M, Raginel T, Favre J, Soueres E, Messaadi N, Deken V, Duhamel A, Berkhout C. Factors associated with the achievement of cervical smears by general practitioners. BMC Res Notes 2017; 10:723. [PMID: 29221494 PMCID: PMC5723048 DOI: 10.1186/s13104-017-2999-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 11/25/2017] [Indexed: 11/23/2022] Open
Abstract
Objective Reliable data about general practitioners performing pap-tests are insufficient. A claim code for the achievement of pap-smears exists in France, but its use by general practitioners is not known. The main purpose of this study was to highlight independent factors associated with the achievement of pap-smears by the general practitioner (GP). We carried out a descriptive and analytic epidemiologic study in 347 GPs and their 244,889 patients, registered at the Health Care Insurance Fund of Flanders. The European Deprivation Index (EDI) in the area of GP’s surgeries was specified. All GPs were questioned by telephone about their performance of pap-tests. The claim database of the insurance fund was analyzed to describe characteristics of GPs. Results The answer rate among questioned GPs was 98.8%. Pap-smears were performed in their surgeries by 182 GPs (53.1%). Among males, 45.7% performed pap-smears versus 78.4% of the female (adjusted odds-ratio = 4.5, p < 0.001). The mean rate of screened women in the target population was 44% when GPs were performing smears versus 42% when they were not (adjusted odds-ratio = 1.04, p = 0.03). Only 19.5% of GPs used the claim code. The number of patients, and the EDI were not associated with pap-smears. Trial registration ClinicalTrials.gov NCT02749110 (April 22, 2016)
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Affiliation(s)
- Michaël Rochoy
- Department of General Practice/Family Medicine, School of Medicine, Lille University UDSL, 59000, Lille, France
| | - Thibaut Raginel
- UCBN, INSERM U1086, Cancers & Preventions, CHU de Caen, Normandie University, 14000, Caen, France.,UCBN, Department of General Medicine, Medical School, Normandie University, 14000, Caen, France
| | - Jonathan Favre
- Department of General Practice/Family Medicine, School of Medicine, Lille University UDSL, 59000, Lille, France
| | - Estelle Soueres
- Department of General Practice/Family Medicine, School of Medicine, Lille University UDSL, 59000, Lille, France
| | - Nassir Messaadi
- Department of General Practice/Family Medicine, School of Medicine, Lille University UDSL, 59000, Lille, France
| | - Valérie Deken
- Department of Public Health, University Hospital Lille, Lille University EA 2694, 59000, Lille, France
| | - Alain Duhamel
- Department of Public Health, University Hospital Lille, Lille University EA 2694, 59000, Lille, France
| | - Christophe Berkhout
- Department of General Practice/Family Medicine, School of Medicine, Lille University UDSL, 59000, Lille, France. .,Department of General Practice/Family Medicine, School of Medicine, Lille University-UDSL, 59045, Lille Cedex, France.
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Prévention primaire et secondaire des cancers féminins : comment améliorer la sensibilisation des femmes ? Une revue de la littérature. Rev Epidemiol Sante Publique 2017; 65:453-465. [DOI: 10.1016/j.respe.2017.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 05/27/2017] [Accepted: 06/12/2017] [Indexed: 11/20/2022] Open
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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.
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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.
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Constantinou P, Sicsic J, Franc C. Effect of pay-for-performance on cervical cancer screening participation in France. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2016; 17:10.1007/s10754-016-9207-3. [PMID: 28005224 DOI: 10.1007/s10754-016-9207-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/04/2016] [Indexed: 06/06/2023]
Abstract
Pay-for-performance (P4P) has been increasingly used across different healthcare settings to incentivize the provision of targeted services. In this study, we investigated the effect of a nationwide P4P scheme for general practitioners implemented in 2012 in France, on cervical cancer screening practices. Using data from a nationally representative permanent sample of health insurance beneficiaries, we analyzed smear test use of eligible women for the years 2006-2014. Our longitudinal sample was an unbalanced panel comprising 180,167 women eligible from 1 to 9 years each. We took into account that during our study period some women were exposed to another incentive for screening participation: the implementation in 2010 of organized screening (OS) in a limited number of areas. To evaluate the effect of P4P, we defined three different measures of smear utilization. For each measure, we specified binary panel-data models to estimate annual probabilities and to compare each estimate to the 2011 baseline level. To explore the combined effect of P4P and OS in areas exposed to both incentives, we computed interaction terms between year dummies and area of residence. We found that P4P had a modest positive effect on recommended screening participation. This effect is likely to be transient as annual smear use, both for the whole sample and among women overdue for screening, increased only in 2013 and decreased again in 2014. The combined effect of P4P and OS on screening participation was not cumulative during the first years of coexistence.
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Affiliation(s)
- Panayotis Constantinou
- INSERM, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Université Paris-Sud, UVSQ, 16, avenue Paul Vaillant Couturier, 94807, Villejuif Cedex, France.
| | - Jonathan Sicsic
- INSERM, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Université Paris-Sud, UVSQ, 16, avenue Paul Vaillant Couturier, 94807, Villejuif Cedex, France
| | - Carine Franc
- INSERM, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Université Paris-Sud, UVSQ, 16, avenue Paul Vaillant Couturier, 94807, Villejuif Cedex, France
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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.
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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
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Bussière C, Sicsic J, Pelletier-Fleury N. Simultaneous effect of disabling conditions on primary health care use through a capability approach. Soc Sci Med 2016; 154:70-84. [DOI: 10.1016/j.socscimed.2016.02.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 02/05/2016] [Accepted: 02/14/2016] [Indexed: 01/16/2023]
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Screening for cervical cancer: What are the determinants among adults with disabilities living in institutions? Findings from a National Survey in France. Health Policy 2015; 119:794-801. [DOI: 10.1016/j.healthpol.2015.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 01/18/2015] [Accepted: 02/04/2015] [Indexed: 11/18/2022]
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Analyse de la pratique du frottis cervico-utérin de dépistage pendant la grossesse en France : étude bicentrique rétrospective de cohorte. ACTA ACUST UNITED AC 2015; 44:516-23. [DOI: 10.1016/j.jgyn.2014.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/05/2014] [Accepted: 07/18/2014] [Indexed: 11/19/2022]
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Abstract
Cervical cancer is the second most common cancer in women worldwide. It represents one of the most challenging public health problems in developing countries. HIV-infected women have a higher risk of cervical cancer which is an AIDS defining cancer. Cervical cancer treatment in HIV-infected and non-infected women is the same. HIV naive women must be prescribed combination antiretroviral therapy at the moment of HIV cancer diagnosis. A close collaboration between oncologist and infectiologist is mandatory to optimize HIV treatment. Among HIV-infected women, PAP-smear screening for early detection and treatment of precancerous cervical lesions is recommended. HPV vaccination is also recommended with the same efficacy and safety profile as the general population.
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Ouédraogo S, Dabakuyo-Yonli TS, Amiel P, Dancourt V, Dumas A, Arveux P. Breast cancer screening programmes: challenging the coexistence with opportunistic mammography. PATIENT EDUCATION AND COUNSELING 2014; 97:410-7. [PMID: 25282326 DOI: 10.1016/j.pec.2014.08.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 08/10/2014] [Accepted: 08/26/2014] [Indexed: 05/06/2023]
Abstract
OBJECTIVE This study investigated predictive factors of women's participation in organized mammography screening (OrgMS) and/or opportunistic mammography screening (OppMS) when the two screening modes coexist. METHODS Questionnaires were sent to 6,000 women aged 51-74 years old invited to attend an OrgMS session between 2010 and 2011 in France. Data collected concerned the women's healthcare behaviour and their socioeconomic characteristics. Women without a personal or family history of breast cancer that could explain their participation in OppMS were retained in the generalized logits analysis. RESULTS The data of 1,202 women were analysed. Of these, 555 (46.2%) had attended OrgMS only, 105 (8.7%) OppMS only and 542 (45.1%) had performed both OrgMS and OppMS. Multivariable analyses showed that women who had regular gynaecological check-ups were more likely to perform OppMS only or both OrgMS and OppMS, OR 95% CI were 2.1 [1.1-3.9], 1.9 [1.4-2.6], respectively. Being employed also increased participation in OppMS only [OR: 2.1 (1.2-3.7)] or both OrgMS and OppMS [OR: 1.5 (1.1-2.05)]. CONCLUSION AND PRACTICE IMPLICATIONS In countries where OrgMS and OppMS coexist, strategies involving gynaecologists, referring doctors or company doctors and the organization of healthcare services to promote adequate screening round may help to reduce the overuse of mammography.
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Affiliation(s)
- Samiratou Ouédraogo
- Breast and Gynaecologic Cancer Registry of Cote d'Or, Georges-François Leclerc Comprehensive Cancer Care Centre, Dijon, France; EA 4184, Medical School, University of Burgundy, Dijon, France.
| | - Tienhan S Dabakuyo-Yonli
- EA 4184, Medical School, University of Burgundy, Dijon, France; Biostatistics and Quality of Life Unit, Georges-François Leclerc Comprehensive Cancer Care Centre, Dijon, France
| | - Philippe Amiel
- Social and Human Sciences Research Unit, Gustave-Roussy Cancer Institute, Villejuif, France
| | - Vincent Dancourt
- Inserm U866, Medical School, University of Burgundy, Dijon, France; Association pour le Dépistage des Cancers en Côte d'Or et dans la Nièvre (ADECA 21-58), Dijon, France
| | - Agnès Dumas
- Social and Human Sciences Research Unit, Gustave-Roussy Cancer Institute, Villejuif, France
| | - Patrick Arveux
- Breast and Gynaecologic Cancer Registry of Cote d'Or, Georges-François Leclerc Comprehensive Cancer Care Centre, Dijon, France; EA 4184, Medical School, University of Burgundy, Dijon, France
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To what extent is women's economic situation associated with cancer screening uptake when nationwide screening exists? A study of breast and cervical cancer screening in France in 2010. Cancer Causes Control 2014; 25:977-83. [PMID: 24842393 DOI: 10.1007/s10552-014-0397-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 05/08/2014] [Indexed: 01/22/2023]
Abstract
PURPOSE In France, larger social inequalities are reported for cervical cancer screening, based on individual practice, than for breast cancer screening for which organized screening exists. Our aim was to investigate the association between women's economic situation and breast and cervical cancer screening. METHODS We used data from a large French national health survey conducted in 2010. The economic situation was assessed using the number of adverse economic conditions respondents were facing, based on three variables (low income, lacking food, and perceived financial difficulties). Logistic regressions were adjusted for socioeconomic and sociodemographic characteristics, healthcare use and insurance, and health behaviors. RESULTS Mammography was less frequent among women experiencing two or more adverse economic conditions, whereas Pap smear was less frequent among women experiencing at least one adverse economic condition. For both screenings, higher rates were observed among women who lived in the Paris region. Sociodemographic indicators and health behaviors were associated with Pap smear, whereas healthcare use and insurance characteristics were associated with mammography. CONCLUSIONS The women's economic situation is an important determinant of breast and cervical cancer screening in France in 2010. Alleviating economic barriers to female cancers screening should be a priority in future programs implementation.
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Oussaid N, Lutringer-Magnin D, Barone G, Haesebaert J, Lasset C. Factors associated with Pap smear screening among French women visiting a general practitioner in the Rhône-Alpes region. Rev Epidemiol Sante Publique 2013; 61:437-45. [PMID: 24012357 DOI: 10.1016/j.respe.2013.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 03/30/2013] [Accepted: 04/04/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To help prevent cervical cancer, three yearly opportunistic Pap smear screening is recommended in France for women aged 25-65 years. Pap smear screening coverage varies with age and socioeconomic level. The aim of this cross-sectional study was to identify factors associated with a low uptake of Pap smear screening among women with no limited access to healthcare. METHODS We analyzed data from women aged 25-65 living in the Rhône-Alpes region who completed a self-administered questionnaire given to them by general practitioners between June and August 2008. The questionnaire covered knowledge about cervical cancer and its prevention as well as the women's history of Pap smear screening and other health-related behaviors. The relationship between low uptake of Pap smear screening--defined as not having had the test within the past 3 years--and a range of possible contributing factors was investigated using logistic regression. RESULTS Of 1186 women with an intact uterus who completed the questionnaire, 89.1% said they had had a Pap smear within the past 3 years. On multivariate analysis, the 10.9% who had not were significantly more likely to live alone (1.76 [1.13-2.74]), to have no children (2.17 [1.31-3.62]), to have never used contraception (5.35 [2.98-9.62]), to have less knowledge about Pap smear screening (3.40 [1.55-7.49]), and to be unvaccinated against hepatitis B (0.55 [0.35-0.87]). CONCLUSION Despite high overall compliance with Pap smear screening recommendations among women who consulted general practitioners, several factors were significantly associated with a low uptake of the service. Considering these factors may help to refine messages aimed at cervical cancer prevention.
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Affiliation(s)
- N Oussaid
- Département de santé publique, centre Léon-Bérard, 69373 Lyon cedex 08, France
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Fon Sing M, Leuraud K, Duport N. Characteristics of French people using organised colorectal cancer screening. Analysis of the 2010 French Health, Healthcare and Insurance Survey. Prev Med 2013; 57:65-8. [PMID: 23541516 DOI: 10.1016/j.ypmed.2013.03.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 03/11/2013] [Accepted: 03/18/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyse relationships between socio-demographic characteristics, healthcare access, and behaviour with regard to participation in organised colorectal cancer (CRC) screening. METHODS We analysed a subset of 2,276 individuals from a cross-sectional population-based survey of French households in 2010. The outcome was participation in CRC screening using multiple logistic regression. The studied variables included socio-demographic characteristics, healthcare access-related variables, and health or perceived health. RESULTS Age, living in a pilot district for CRC screening, and having a private additional insurance were associated with participation in CRC screening for both genders. In men, other characteristics were associated: not having 100% coverage for medical fees for a long-term disease, having consulted a medical specialist in the last 12 months, and not smoking. In women, other cancer screening behaviours were associated with participation in CRC screening. Results also showed that 81.4% of individuals, who did not have a Hemoccult® test, consulted a GP in the last 12 months. CONCLUSIONS Despite efforts made, results confirmed that CRC screening differed among socioeconomic groups. GPs should be encouraged to systematically recommend CRC screening to their patients fitting the criteria of the organised CRC screening programme and further investigation is required to optimise information strategies targeting GPs.
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Affiliation(s)
- Mélanie Fon Sing
- Département des Maladies Chroniques et Traumatismes, Institut de Veille Sanitaire (InVS), French Institute for Public Health Surveillance, 12, rue du Val d'Osne, 94415 Saint-Maurice Cedex, France.
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Rouëssé J. Accès aux soins et inégalité sociale. ONCOLOGIE 2013. [DOI: 10.1007/s10269-012-2240-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Duport N. Characteristics of women using organized or opportunistic breast cancer screening in France. Analysis of the 2006 French Health, Health Care and Insurance Survey. Rev Epidemiol Sante Publique 2012; 60:421-30. [DOI: 10.1016/j.respe.2012.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 02/23/2012] [Accepted: 05/07/2012] [Indexed: 11/28/2022] Open
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Prácticas de cribado de cáncer y estilos de vida asociados en la población de controles del estudio español multi-caso control (MCC-Spain). GACETA SANITARIA 2012; 26:301-10. [DOI: 10.1016/j.gaceta.2012.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Revised: 01/03/2012] [Accepted: 01/09/2012] [Indexed: 11/17/2022]
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Fournel I, Cottet V, Binquet C, Jooste V, Faivre J, Bouvier AM, Bonithon-Kopp C. Rural-urban inequalities in detection rates of colorectal tumours in the population. Dig Liver Dis 2012; 44:172-7. [PMID: 22000155 DOI: 10.1016/j.dld.2011.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 07/25/2011] [Accepted: 09/13/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Because few data are available on this topic, we investigated the influence of geographical determinants on colorectal adenoma detection and cancer incidence rates. METHODS Between 1990 and 1999, 6220 Côte d'Or inhabitants (France) were first-diagnosed with a colorectal adenoma, and 2389 with an invasive adenocarcinoma. The impact of the rural-urban place of residence and of a physician location in municipalities on adenoma and cancer detection rates was studied using Poisson regression. RESULTS World-standardized adenoma detection rate was significantly higher in urban areas (102 [95% CI: 97-107]) than in rural areas (78 [95% CI: 72-84]). The impact of the absence of physicians in municipalities was only found in rural areas. The detection rate ratio associated with the absence of a primary care physician was 0.70 [95% CI: 0.61-0.81], and the detection rate ratio associated with the absence of a gastroenterologist was 0.75 [95% CI: 0.64-0.89]. Colorectal cancer incidence rates were similar in urban and rural areas with only marginal variations related to physician location. CONCLUSIONS These results suggested a differential impact of geographical variables on the detection rates of colorectal adenomas and cancers in the population. Further studies are needed to examine socio-economic factors likely to be involved in these disparities.
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Impact du statut socioéconomique sur la gravité du diagnostic initial de cancer du sein. Rev Epidemiol Sante Publique 2012; 60:19-29. [DOI: 10.1016/j.respe.2011.08.066] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 06/23/2011] [Accepted: 08/29/2011] [Indexed: 11/23/2022] Open
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Rigal L, Saurel-Cubizolles MJ, Falcoff H, Bouyer J, Ringa V. Do social inequalities in cervical cancer screening persist among patients who use primary care? The Paris Prevention in General Practice survey. Prev Med 2011; 53:199-202. [PMID: 21726576 DOI: 10.1016/j.ypmed.2011.06.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 06/17/2011] [Accepted: 06/18/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Social inequalities in cervical cancer screening may be related to either lack of access to care or inadequate delivery of preventive care by providers. We sought to characterize social inequalities among women consulting general practitioners with a wide range of social position indicators. METHODS In 2005-06, 59 randomly recruited general practitioners from the Paris metropolitan area enrolled every woman aged 50-69 years seen during a two-week period. Cervical cancer screening status (overdue if the last cervical cancer screening had been more than 3 years earlier) was analyzed for 858 women in a logistic mixed model that considered: occupational class (in 5 levels, based on last occupation), education, income, characteristics related to family, housing, neighborhood, household wealth (social allocations, perceived financial difficulties in 4 levels, income tax), employment status, supplementary health insurance, and social network (4 levels). RESULTS The rate of overdue patients did not vary between general practitioners (21%). social position indicators associated with overdue status (odds ratio between 2 adjacent decreasing social levels) were occupational class (1.20, 95% CI: 1.03-1.41), social network (1.52, 95% CI: 1.18-1.94), financial difficulties (1.42, 95% CI: 1.07-1.88), neighborhood safety (2.15, 95% CI: 1.10-4.20), and allocations (3.34, 95% CI: 1.12-9.96). CONCLUSIONS Even among women visiting general practitioners we observed marked social inequalities that persist above and beyond occupational class.
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Affiliation(s)
- L Rigal
- Université Paris-Descartes, Faculté de Médecine, Department of Family Medicine, F-75014, Paris, France.
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Daubisse-Marliac L, Delafosse P, Boitard J, Poncet F, Grosclaude P, Colonna M. Breast cancer incidence and time trend in France from 1990 to 2007: a population-based study from two French cancer registries. Ann Oncol 2011; 22:329-34. [DOI: 10.1093/annonc/mdq396] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Couëpel L, Bourgarel S, Piteau-Delord M. Dépistage du cancer chez les personnes handicapées : pratiques et difficultés spécifiques en établissement médico-social. ACTA ACUST UNITED AC 2011. [DOI: 10.3917/pos.424.0245] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Vacher-Lavenu MC. Dépistage du cancer du col utérin : actualités en 2010. Ann Pathol 2010; 30:28-31. [DOI: 10.1016/j.annpat.2010.07.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 07/28/2010] [Indexed: 11/26/2022]
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Prevalence of treated diabetes: Geographical variations at the small-area level and their association with area-level characteristics. A multilevel analysis in Southeastern France. DIABETES & METABOLISM 2010; 37:39-46. [PMID: 20980182 DOI: 10.1016/j.diabet.2010.07.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 07/13/2010] [Accepted: 07/17/2010] [Indexed: 01/27/2023]
Abstract
AIM This study estimated geographical variations in the prevalence of treated diabetes (TD) at the small-area level in Southeastern France to determine whether or not the characteristics of these areas (in particular, socioeconomic status or "SES") are associated with TD independent of person-level factors. METHODS The study used drug reimbursement data for 2008 from the General Health Insurance Scheme in Southeastern France for beneficiaries aged 18 years or over. TD patients were defined as those to whom oral antidiabetic drugs or insulin had been dispensed at least three times within the year. Area (canton) characteristics associated with the prevalence of TD were studied using multilevel Poisson regression. RESULTS In 2008, the crude prevalence of TD in adults in Southeastern France was 5.14%. In addition, TD prevalence was significantly higher in the more deprived and population-dense cantons independent of person-level factors (age, gender, low SES). CONCLUSION This study found a positive association between area deprivation and TD, and adds further evidence to the scanty data so far available on this topic. This finding should contribute to pinpointing priority action areas for programmes of diabetes prevention. However, more research is needed to further elucidate the mechanism(s) linking area deprivation and diabetes.
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