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Stephanopoli JP, Bouazzi L, Guerbaz-Sommi M, Graesslin O, Hurtaud A, Ilardo S, Chrusciel J, Barbaret C, Bertrand C, Sanchez S. Factors associated with deferral or non-performance of an organized breast cancer screening program during the COVID-19 pandemic in France. Cancer Med 2024; 13:e7444. [PMID: 39192606 DOI: 10.1002/cam4.7444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 06/12/2024] [Accepted: 06/18/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Delays in detection and treatment of breast cancer can lead to increased mortality. To date, participation in organized breast cancer screenings (OBCS) has been suboptimal worldwide. The objective of this study was to investigate the factors associated with deferral or non-performance of mammography during the COVID-19 pandemic for women who had previously participated in OBCS. METHODS A retrospective observational study was conducted on a cohort of 6282 women from the Aube Department of France, who were invited to an OBCS in 2020. Participants were divided into women who promptly underwent screening after receiving an invitation (between 22 and 25 months elapsed since the last mammogram), women who underwent late screening (≥26 months since the last mammogram), and those who were never screened. Data were collected from a self-reported questionnaire. Comparative and multivariable analyses modeling the probability of each type of attendance were performed using these data. RESULTS In total, 2301 women (aged 50-74 years) returned a valid questionnaire. Compared to women who promptly underwent mammography, non- and late-screening participants were younger, had less frequent gynecological follow-up and a less frequent history of colorectal cancer screening. Women with higher education status and those residing in socially disadvantaged areas were more likely to attend late. CONCLUSION The absence of regular gynecological follow-up and the absence of colorectal cancer screening were significant factors associated with deferral of or non-attendance at OBCS.
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Affiliation(s)
- Jean Papadacci Stephanopoli
- Department of General Medicine, Université de Reims Champagne-Ardenne, Reims, Marne, France
- Médecine générale, Maison de Santé Pluriprofessionnelle de la Forêt d'Orient, Piney, Aube, France
| | - Leila Bouazzi
- Comité Universitaire de Ressources pour la Recherche en Santé,, Université de Reims Champagne-Ardenne, Reims, Marne, France
| | - Myriam Guerbaz-Sommi
- CRCDC, Centre Régional de Coordination des Dépistages des Cancers du Grand Est, Troyes, Aube, France
| | - Olivier Graesslin
- Department of Gynecology and Obstetrics, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, Marne, France
| | - Aline Hurtaud
- Department of General Medicine, Université de Reims Champagne-Ardenne, Reims, Marne, France
| | - Salvatore Ilardo
- Médecine générale, Maison de Santé Pluriprofessionnelle de la Forêt d'Orient, Piney, Aube, France
| | - Jan Chrusciel
- Department of Public Health and Performance, Centre Hospitalier de Troyes, Troyes, France
| | - Cécile Barbaret
- Univ. Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble Institute of Engineering, TIMC-IMAG,, Univ. Grenoble Alpes,, Grenoble, isère, France
| | - Camille Bertrand
- CRCDC, Centre Régional de Coordination des Dépistages des Cancers du Grand Est, Troyes, Aube, France
| | - Stéphane Sanchez
- Comité Universitaire de Ressources pour la Recherche en Santé,, Université de Reims Champagne-Ardenne, Reims, Marne, France
- Department of Public Health and Performance, Centre Hospitalier de Troyes, Troyes, France
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Ngô C, Bonsang-Kitzis H, Charreire H, Bochaton A, Conti B, Baffert S, Beauvais A, Arnoux A, Lécuru F, Desprès C. [Impact of precariousness on breast cancer care in the Île-de-France region: Results of the DESSEIN study]. Bull Cancer 2024; 111:635-645. [PMID: 38876896 DOI: 10.1016/j.bulcan.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Precariousness has been associated with an increase in breast cancer mortality, but the links between precariousness, stage at diagnosis and care pathways are little explored. The objective of the DESSEIN study was to assess the impact of precariousness on disease and care pathways. METHODS Prospective observational study in Île-de-France comparing precarious and non-precarious patients consulting for breast cancer and followed for 1 year. RESULTS In total, 875 patients were included between 2016 and 2019 in 19 institutions: 543 non-precarious patients and 332 precarious patients. Precarious patients had a more advanced stage at diagnosis (55% T1 vs. 63%, 30% N+ vs 19%, P=0.0006), had a higher risk of not receiving initially planned treatment (4 vs. 1%, P=0.004), and participated less in clinical trials (5 vs. 9%, P=0.03). Non-use of supportive oncology care was 2 times more frequent among patients in precarious situations (P<0.001). During treatment, 33% of deprived patients reported a loss of income, compared with 24% of non-deprived patients (P<0.001). At 12 months from diagnosis, lay-offs were 2 times more frequent in precarious patients (P=0.0001). DISCUSSION Precariousness affects all stages of the cancer history and care pathway. Particular attention needs to be paid to vulnerable populations, considering issues of accessibility and affordability of care, health literacy and possible implicit bias from the care providers.
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Affiliation(s)
- Charlotte Ngô
- Hôpital privé des peupliers, Ramsay santé, 8, place de l'Abbé-Georges-Hénocque, 75013 Paris, France; Équipe EtreS, centre de recherche des cordeliers, Sorbonne université, université de Paris, Inserm, 15, rue de l'École de Médecine, 75006 Paris, France.
| | - Hélène Bonsang-Kitzis
- Hôpital privé des peupliers, Ramsay santé, 8, place de l'Abbé-Georges-Hénocque, 75013 Paris, France
| | - Hélène Charreire
- MoISA, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, université de Montpellier, Montpellier, France
| | | | - Benoît Conti
- École des Ponts, LVMT, université Gustave-Eiffel, 77454 Marne-la-Vallée, France
| | - Sandrine Baffert
- CEMKA, 43, boulevard du Maréchal-Joffre, 92340 Bourg-la-Reine, France
| | | | - Armelle Arnoux
- Unité de recherche clinique, center d'investigation clinique 1418 épidémiologie clinique, université Paris Cité, AP-HP, hôpital Européen Georges-Pompidou, Inserm, Paris, France
| | - Fabrice Lécuru
- Département de chirurgie, Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Caroline Desprès
- Équipe EtreS, centre de recherche des cordeliers, Sorbonne université, université de Paris, Inserm, 15, rue de l'École de Médecine, 75006 Paris, France
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Borghi G, Delacôte C, Delacour-Billon S, Ayrault-Piault S, Dabakuyo-Yonli TS, Delafosse P, Woronoff AS, Trétarre B, Molinié F, Cowppli-Bony A. Socioeconomic Deprivation and Invasive Breast Cancer Incidence by Stage at Diagnosis: A Possible Explanation to the Breast Cancer Social Paradox. Cancers (Basel) 2024; 16:1701. [PMID: 38730653 PMCID: PMC11083525 DOI: 10.3390/cancers16091701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
In this study, we assessed the influence of area-based socioeconomic deprivation on the incidence of invasive breast cancer (BC) in France, according to stage at diagnosis. All women from six mainland French departments, aged 15+ years, and diagnosed with a primary invasive breast carcinoma between 2008 and 2015 were included (n = 33,298). Area-based socioeconomic deprivation was determined using the French version of the European Deprivation Index. Age-standardized incidence rates (ASIR) by socioeconomic deprivation and stage at diagnosis were compared estimating incidence rate ratios (IRRs) adjusted for age at diagnosis and rurality of residence. Compared to the most affluent areas, significantly lower IRRs were found in the most deprived areas for all-stages (0.85, 95% CI 0.81-0.89), stage I (0.77, 95% CI 0.72-0.82), and stage II (0.84, 95% CI 0.78-0.90). On the contrary, for stages III-IV, significantly higher IRRs (1.18, 95% CI 1.08-1.29) were found in the most deprived areas. These findings provide a possible explanation to similar or higher mortality rates, despite overall lower incidence rates, observed in women living in more deprived areas when compared to their affluent counterparts. Socioeconomic inequalities in access to healthcare services, including screening, could be plausible explanations for this phenomenon, underlying the need for further research.
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Affiliation(s)
- Giulio Borghi
- Loire-Atlantique/Vendée Cancer Registry, 44093 Nantes, France
| | - Claire Delacôte
- Loire-Atlantique/Vendée Cancer Registry, 44093 Nantes, France
- SIRIC ILIAD INCa-DGOS-INSERM-ITMO Cancer_18011, CHU Nantes, 44000 Nantes, France
| | - Solenne Delacour-Billon
- Loire-Atlantique/Vendée Cancer Registry, 44093 Nantes, France
- SIRIC ILIAD INCa-DGOS-INSERM-ITMO Cancer_18011, CHU Nantes, 44000 Nantes, France
- French Network of Cancer Registries (FRANCIM), 31000 Toulouse, France
| | - Stéphanie Ayrault-Piault
- Loire-Atlantique/Vendée Cancer Registry, 44093 Nantes, France
- SIRIC ILIAD INCa-DGOS-INSERM-ITMO Cancer_18011, CHU Nantes, 44000 Nantes, France
- French Network of Cancer Registries (FRANCIM), 31000 Toulouse, France
| | - Tienhan Sandrine Dabakuyo-Yonli
- French Network of Cancer Registries (FRANCIM), 31000 Toulouse, France
- Côte d’Or Breast and Gynaecologic Cancer Registry, INSERM U1231, 21000 Dijon, France
| | - Patricia Delafosse
- French Network of Cancer Registries (FRANCIM), 31000 Toulouse, France
- Isère Cancer Registry, 38000 Grenoble, France
| | - Anne-Sophie Woronoff
- French Network of Cancer Registries (FRANCIM), 31000 Toulouse, France
- Doubs Cancer Registry, 25000 Besançon, France
| | - Brigitte Trétarre
- French Network of Cancer Registries (FRANCIM), 31000 Toulouse, France
- Hérault Cancer Registry, 34000 Montpellier, France
- EQUITY Research Team (Certified by the French League Against Cancer), CERPOP, UMR 1295, Université Toulouse III Paul Sabatier, 31000 Toulouse, France
| | - Florence Molinié
- Loire-Atlantique/Vendée Cancer Registry, 44093 Nantes, France
- SIRIC ILIAD INCa-DGOS-INSERM-ITMO Cancer_18011, CHU Nantes, 44000 Nantes, France
- French Network of Cancer Registries (FRANCIM), 31000 Toulouse, France
- EQUITY Research Team (Certified by the French League Against Cancer), CERPOP, UMR 1295, Université Toulouse III Paul Sabatier, 31000 Toulouse, France
| | - Anne Cowppli-Bony
- Loire-Atlantique/Vendée Cancer Registry, 44093 Nantes, France
- SIRIC ILIAD INCa-DGOS-INSERM-ITMO Cancer_18011, CHU Nantes, 44000 Nantes, France
- French Network of Cancer Registries (FRANCIM), 31000 Toulouse, France
- EQUITY Research Team (Certified by the French League Against Cancer), CERPOP, UMR 1295, Université Toulouse III Paul Sabatier, 31000 Toulouse, France
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4
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Guigon L, Sánchez LXG, Petit AS, Bonniec AL, Basu P, Rodrigue CM, Préau M, Soler-Michel P, Villain P. Would shared decision-making be useful in breast cancer screening programmes? A qualitative study using focus group discussions to gather evidence from French women with different socioeconomic backgrounds. BMC Public Health 2024; 24:404. [PMID: 38326802 PMCID: PMC10851553 DOI: 10.1186/s12889-024-17876-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/24/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND To inform the development of an online tool to be potentially used in shared decision-making about breast cancer screening, French women were questioned about participation in breast cancer screening, the health professional's role, and their perceptions of the proposed tool. METHODS We organised focus group discussions with 55 French women. Two different strategies were used to recruit women from high and low socioeconomic backgrounds. We applied both inductive and deductive approaches to conduct a thematic analysis of the discussions. We analysed the responses by using the main determinants from different health behaviour models and compared the two groups. RESULTS Independently of socioeconomic status, the most important determinant for a woman's participation in breast cancer screening was the perceived severity of breast cancer and the perceived benefits of its early detection by screening. Cues to action reported by both groups were invitation letters; recommendations by health professionals, or group/community activities and public events were reported by women from high and low socioeconomic backgrounds, respectively. Among other positive determinants, women from high socioeconomic backgrounds reported making informed decisions and receiving peer support whereas women from low socioeconomic backgrounds reported community empowerment through group/community events. Fear of cancer was reported as a barrier in both groups. Among other barriers, language issues were reported only by women from low socioeconomic backgrounds; women from high socioeconomic backgrounds reported breast cancer screening-related risks other than overdiagnosis and/or overtreatment. Barriers to accessing the online tool to be developed were mainly reported by women from high socioeconomic backgrounds. CONCLUSION Limitations in implementing shared decision-making for women from low socioeconomic backgrounds were highlighted. An online tool that is suitable for all women, regardless of socioeconomic status, would provide "on-demand" reliable and tailored information about breast cancer screening and improve access to health professionals and social exchanges.
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Affiliation(s)
- Laureline Guigon
- Early Detection, Prevention, and Infections (EPR) Branch, International Agency for Research on Cancer (IARC-WHO), 25 Avenue Tony Garnier, 69007, Lyon, France
| | - Laura X Gil Sánchez
- Early Detection, Prevention, and Infections (EPR) Branch, International Agency for Research on Cancer (IARC-WHO), 25 Avenue Tony Garnier, 69007, Lyon, France
| | - Anne-Sophie Petit
- Unité Inserm, Université Lumière Lyon, 1296 « Radiations: Défense, Santé, Environnement », Lyon, France
| | - Alice Le Bonniec
- Early Detection, Prevention, and Infections (EPR) Branch, International Agency for Research on Cancer (IARC-WHO), 25 Avenue Tony Garnier, 69007, Lyon, France
| | - Partha Basu
- Early Detection, Prevention, and Infections (EPR) Branch, International Agency for Research on Cancer (IARC-WHO), 25 Avenue Tony Garnier, 69007, Lyon, France
| | - Christelle M Rodrigue
- Centre Régional de Coordination des Dépistages des Cancers (CRCDC) Auvergne-Rhône-Alpes, Site Rhône & Métropole de Lyon, Lyon, France
| | - Marie Préau
- Unité Inserm, Université Lumière Lyon, 1296 « Radiations: Défense, Santé, Environnement », Lyon, France
| | - Patricia Soler-Michel
- Centre Régional de Coordination des Dépistages des Cancers (CRCDC) Auvergne-Rhône-Alpes, Site Rhône & Métropole de Lyon, Lyon, France
| | - Patricia Villain
- Early Detection, Prevention, and Infections (EPR) Branch, International Agency for Research on Cancer (IARC-WHO), 25 Avenue Tony Garnier, 69007, Lyon, France.
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Delacôte C, Ariza JM, Delacour-Billon S, Ayrault-Piault S, Borghi G, Menanteau K, Bouron A, Métais M, Cowppli-Bony A, Molinié F. Socioeconomic and geographic disparities of breast cancer incidence according to stage at diagnosis in France. Cancer Causes Control 2024; 35:241-251. [PMID: 37697113 DOI: 10.1007/s10552-023-01779-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/17/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE Low socioeconomic background (SB) has been associated with lower breast cancer (BC) incidence and higher BC mortality. One explanation of this paradox is the higher frequency of advanced BC observed in deprived women. However, it is still unclear if SB affects similarly BC incidence. This study investigated the link between SB and early/advanced BC incidence from Loire-Atlantique/Vendee Cancer registry data (France). MATERIALS AND METHODS Fourteen thousand three hundred fifty three women living in the geographic area covered by the registry and diagnosed with a primary BC in 2008-2015 were included. SB was approached by a combination of two ecological indexes (French European Deprivation Index and urban/rural residence place). Mixed effects logistic and Poisson regressions were used, respectively, to estimate the odds of advanced (stage ≥ II) BC and the ratio of incidence rates of early (stage 0-I) and advanced BC according to SB, overall and by age group (< 50, 50-74, ≥ 75). RESULTS Compared to women living in affluent-urban areas, women living in deprived-urban and deprived-rural areas had a higher proportion of advanced BC [respectively, OR = 1.11 (1.01-1.22), OR = 1.60 (1.25-2.06)] and lower overall (from - 6 to - 15%) and early (from - 9 to - 31%) BC incidences rates Advanced BC incidence rates were not influenced by SB. These patterns were similar in women under 75 years, especially in women living in deprived-rural areas. In the elderly, no association between SB and BC frequency/incidence rates by stage was found. CONCLUSION Although advanced BC was more frequent in women living in deprived and rural areas, SB did not influence advanced BC incidence. Therefore, differences observed in overall BC incidence according to SB were only due to higher incidence of early BC in affluent and urban areas. Future research should confirm these results in other French areas.
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Affiliation(s)
- Claire Delacôte
- Registre des Cancers de Loire-Atlantique et de Vendée, Nantes, France.
- SIRIC ILIAD INCa-DGOS-Inserm_12558, Nantes, France.
| | - Juan Manuel Ariza
- Registre des Cancers de Loire-Atlantique et de Vendée, Nantes, France
- SIRIC ILIAD INCa-DGOS-Inserm_12558, Nantes, France
| | - Solenne Delacour-Billon
- Registre des Cancers de Loire-Atlantique et de Vendée, Nantes, France
- French Network of Cancer Registries (FRANCIM), Toulouse, France
| | - Stéphanie Ayrault-Piault
- Registre des Cancers de Loire-Atlantique et de Vendée, Nantes, France
- French Network of Cancer Registries (FRANCIM), Toulouse, France
| | - Giulio Borghi
- Registre des Cancers de Loire-Atlantique et de Vendée, Nantes, France
| | - Katia Menanteau
- Registre des Cancers de Loire-Atlantique et de Vendée, Nantes, France
| | - Aurélie Bouron
- Registre des Cancers de Loire-Atlantique et de Vendée, Nantes, France
| | - Magali Métais
- Registre des Cancers de Loire-Atlantique et de Vendée, Nantes, France
| | - Anne Cowppli-Bony
- Registre des Cancers de Loire-Atlantique et de Vendée, Nantes, France
- SIRIC ILIAD INCa-DGOS-Inserm_12558, Nantes, France
- French Network of Cancer Registries (FRANCIM), Toulouse, France
- Equipe Constitutive du CERPOP, UMR 1295, Inserm, Equipe EQUITY, Université Toulouse III, Toulouse, France
| | - Florence Molinié
- Registre des Cancers de Loire-Atlantique et de Vendée, Nantes, France
- SIRIC ILIAD INCa-DGOS-Inserm_12558, Nantes, France
- French Network of Cancer Registries (FRANCIM), Toulouse, France
- Equipe Constitutive du CERPOP, UMR 1295, Inserm, Equipe EQUITY, Université Toulouse III, Toulouse, France
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Ouanhnon L, Bugat MER, Druel V, Grosclaude P, Delpierre C. Link between the referring physician and breast and cervical cancers screening: a cross-sectional study in France. BMC PRIMARY CARE 2023; 24:167. [PMID: 37644404 PMCID: PMC10464303 DOI: 10.1186/s12875-023-02122-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/03/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND The aims of the "médecin traitant" or referring physician (RP) reform, introduced in France in 2004, were to improve the organisation and quality of care and to allow for greater equity, particularly in terms of prevention. The objective of our study was to evaluate the effect of having a declared RP on the uptake of screening for breast and cervical cancers, and to explore the mechanisms involved. METHODS We used an existing dataset of 1,072,289 women, which combines data from the Health Insurance information systems, with census data. We built multivariable logistic regression models to study the effect of having a RP on the uptake of mammography and pap smear, adjusted for age, socio-economic level, health status and healthcare provision. We secondarily added to this model the variable "having consulted a General Practitioner (GP) within the year". Finally, we evaluated the interaction between the effect of having a referring physician and the area of residence (metropolitan/urban/rural). RESULTS Patients who had a declared RP had a significantly higher uptake of mammography and pap smear than those who did not. The strength of the association was particularly important in very urban areas. The effect of having visited a GP seemed to explain a part of the correlation between having a RP and uptake of screening. CONCLUSIONS Lower rates of gynaecological screening among women without an RP compared to those with an RP may partly reflect a specific behaviour pattern in women less adherent to the health care system. However, this result also shows the importance of the RP, who assumes the key role of relaying public health information in a more personalised and adapted way.
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Affiliation(s)
- Lisa Ouanhnon
- Département Universitaire de Médecine Générale, Université Toulouse 3 Paul Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.
- Equity Team : Labelled By the French League Against Cancer, UMR 1295 CERPOP, Inserm, Université Toulouse III, Toulouse, France.
| | - Marie-Eve Rouge Bugat
- Département Universitaire de Médecine Générale, Université Toulouse 3 Paul Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France
- Equity Team : Labelled By the French League Against Cancer, UMR 1295 CERPOP, Inserm, Université Toulouse III, Toulouse, France
| | - Vladimir Druel
- Département Universitaire de Médecine Générale, Université Toulouse 3 Paul Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France
- Equity Team : Labelled By the French League Against Cancer, UMR 1295 CERPOP, Inserm, Université Toulouse III, Toulouse, France
| | - Pascale Grosclaude
- Equity Team : Labelled By the French League Against Cancer, UMR 1295 CERPOP, Inserm, Université Toulouse III, Toulouse, France
- Institut Claudius Regaud, IUCT-O, Registre Des Cancers du Tarn, F-31059, Toulouse, France
| | - Cyrille Delpierre
- Equity Team : Labelled By the French League Against Cancer, UMR 1295 CERPOP, Inserm, Université Toulouse III, Toulouse, France
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Nari F, Park J, Kim N, Kim DJ, Jun JK, Choi KS, Suh M. Impact of health disparities on national breast cancer screening participation rates in South Korea. Sci Rep 2023; 13:13172. [PMID: 37580427 PMCID: PMC10425442 DOI: 10.1038/s41598-023-40164-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/05/2023] [Indexed: 08/16/2023] Open
Abstract
Socioeconomic barriers to cancer screening exist at a regional level. The deprivation index is used to estimate socioeconomic gradients and health disparities across different geographical regions. We aimed to examine the impact of deprivation on breast cancer screening participation rates among South Korean women. Municipal breast cancer screening participation rates in women were extracted from the National Cancer Screening Information System and linked to the Korean version of the deprivation index constructed by the Korea Institute for Health and Social Affairs. A generalised linear mixed model was employed to investigate the association between the deprivation index and age-standardised breast cancer screening participation rates in 2005, 2012, and 2018. Participation rates increased gradually across all age groups from 2005 to 2018. Participants in their 60 s consistently had one of the highest participation rates (2005: 30.37%, 2012: 61.57%, 2018: 65.88%). In 2005, the most deprived quintile had a higher estimate of breast cancer screening participation than the least deprived quintile (2nd quintile; estimate: 1.044, p = 0.242, 3rd quintile; estimate: 1.153, p = 0.192, 4th quintile; estimate: 3.517, p = 0.001, 5th quintile; estimate: 6.913, p = < 0.0001). In 2012, the participation rate also increased as the level of deprivation increased. There were no statistically meaningful results in 2018. Regions with high deprivation have a higher participation rate in breast cancer screening. The role of health disparities in determining cancer outcomes among women in Korea requires further examination.
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Affiliation(s)
- Fatima Nari
- National Cancer Control Institute, National Cancer Center, 323-Ilsan-Ro, Goyang, 10408, Republic of Korea
| | - Juwon Park
- National Cancer Control Institute, National Cancer Center, 323-Ilsan-Ro, Goyang, 10408, Republic of Korea
| | - Nayeon Kim
- National Cancer Control Institute, National Cancer Center, 323-Ilsan-Ro, Goyang, 10408, Republic of Korea
| | - Dong Jin Kim
- Center for Health Policy Research, Korea Institute for Health and Social Affairs, Sejong City, 30147, Republic of Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, 323-Ilsan-Ro, Goyang, 10408, Republic of Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, 10408, Republic of Korea
| | - Kui Son Choi
- National Cancer Control Institute, National Cancer Center, 323-Ilsan-Ro, Goyang, 10408, Republic of Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, 10408, Republic of Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, 323-Ilsan-Ro, Goyang, 10408, Republic of Korea.
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, 10408, Republic of Korea.
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8
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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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9
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Delacôte C, Delacour-Billon S, Ayrault-Piault S, Tagri AD, Rousseau G, Vincent M, Amossé S, Delpierre C, Cowppli-Bony A, Molinié F. Is survival rate lower after breast cancer in deprived women according to disease stage? Br J Cancer 2023; 128:63-70. [PMID: 36319847 PMCID: PMC9814909 DOI: 10.1038/s41416-022-02024-w] [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: 02/22/2022] [Revised: 10/04/2022] [Accepted: 10/12/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Socioeconomic deprivation has been associated with lower breast cancer (BC) survival, but the influence of stage at diagnosis on this association merits further study. Our aim was to investigate this association using the Loire-Atlantique/Vendee Cancer Registry (France). METHODS Twelve-thousand seven-hundred thirty-eight women living in the area covered by the registry and diagnosed with invasive breast carcinoma between 2008 and 2015 were included in the study. They were censored at maximal 6 years. Deprivation was measured by the French European Deprivation Index. Excess hazard and net survival were estimated for deprivation level, stage and age at diagnosis using a flexible excess mortality hazard model. RESULTS After adjustment by stage, women living in the most deprived areas had a borderline non-significant higher excess mortality hazard (+25% (95% CI: -3%; +62%)) compared to those living in the least deprived areas. Stage-adjusted 5-year net survival differed significantly between these two subgroups (respectively, 88.2% (95% CI:85.2%-90.5%) and 92.5% (95% CI:90.6%-93.9%)). CONCLUSION BC survival remained lower in deprived areas in France, despite universal access to cancer care. Intensification of prevention measures could help to reduce advanced BC, responsible for the majority of deaths from BC. A better understanding of remaining social disparities is crucial to implement specific interventions.
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Affiliation(s)
- Claire Delacôte
- Loire-Atlantique/Vendée Cancer Registry, Nantes, France. .,SIRIC ILIAD INCa-DGOS-Inserm_12558, Nantes, France. .,SIRIC ILIAD INCa-DGOS-Inserm_12558, Angers, France.
| | - Solenne Delacour-Billon
- Loire-Atlantique/Vendée Cancer Registry, Nantes, France ,French Network of Cancer Registries (FRANCIM), Toulouse, France
| | - Stéphanie Ayrault-Piault
- Loire-Atlantique/Vendée Cancer Registry, Nantes, France ,French Network of Cancer Registries (FRANCIM), Toulouse, France
| | | | | | | | - Sophie Amossé
- Loire-Atlantique/Vendée Cancer Registry, Nantes, France
| | - Cyrille Delpierre
- grid.15781.3a0000 0001 0723 035XCERPOP, UMR 1295, Université Toulouse III, Inserm, Equipe EQUITY, Toulouse, France
| | - Anne Cowppli-Bony
- Loire-Atlantique/Vendée Cancer Registry, Nantes, France ,SIRIC ILIAD INCa-DGOS-Inserm_12558, Nantes, France ,SIRIC ILIAD INCa-DGOS-Inserm_12558, Angers, France ,French Network of Cancer Registries (FRANCIM), Toulouse, France ,grid.15781.3a0000 0001 0723 035XCERPOP, UMR 1295, Université Toulouse III, Inserm, Equipe EQUITY, Toulouse, France
| | - Florence Molinié
- Loire-Atlantique/Vendée Cancer Registry, Nantes, France ,SIRIC ILIAD INCa-DGOS-Inserm_12558, Nantes, France ,SIRIC ILIAD INCa-DGOS-Inserm_12558, Angers, France ,French Network of Cancer Registries (FRANCIM), Toulouse, France ,grid.15781.3a0000 0001 0723 035XCERPOP, UMR 1295, Université Toulouse III, Inserm, Equipe EQUITY, Toulouse, France
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10
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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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11
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Bailly L, Jobert T, Petrovic M, Pradier C. Factors influencing participation in breast cancer screening in an urban setting. A study of organized and individual opportunistic screening among potentially active and retired women in the city of Nice. Prev Med Rep 2022; 31:102085. [PMID: 36820373 PMCID: PMC9938307 DOI: 10.1016/j.pmedr.2022.102085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Participation in breast cancer screening in urban settings is poor. Identifying factors accounting for participation and non-participation is essential to target priority areas, tackle health inequalities and suggest innovative approaches. We studied organized and individual opportunistic participation in breast cancer screening within the 144 aggregated units for statistical information (Ilôts regroupés pour l'information statistique: IRIS) of the city of Nice from 2019 to 2021. In each IRIS was assessed a local human development index, among potentially active women aged 50 to 59 years and retired women aged 60 to 74 years. Modelling participation and non-participation in screening according to the IRIS units' socio-economical characteristics was performed using the SURE method (Seemingly Unrelated Regression Equations). Over a 2-year period, 24,396 breast screening tests were conducted (11,173 as organised screening, 13,223 as individual opportunistic screening). The local human development index was positively correlated with the two types of screening, respectively. Access to public transport facilitated participation. Managerial status was negatively correlated with organised screening. Single working women had a higher risk of non-participation. With regard to their socio-economic characteristics, screening rates were lower than expected in 16 IRIS units in the city of Nice. Local human development index, access to public transport, family and professional context appear to be associated with breast cancer screening in an urban setting. An innovative approach targeting these factors is called for to reduce health inequalities.
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Affiliation(s)
- Laurent Bailly
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Department of Public Health, UR2CA, Nice, France
- Corresponding author.
| | - Thomas Jobert
- Université Côte d'Azur, CNRS, GREDEG, 250 rue Albert Einstein, Valbonne 06560, France
| | - Mirko Petrovic
- Université Côte d’Azur, EUR ELMI, Rue du 22ème B.C.A., Nice 06300, France
| | - Christian Pradier
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Department of Public Health, UR2CA, Nice, France
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12
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Quintin C, Chatignoux E, Plaine J, Hamers FF, Rogel A. Coverage rate of opportunistic and organised breast cancer screening in France: Department-level estimation. Cancer Epidemiol 2022; 81:102270. [PMID: 36215917 DOI: 10.1016/j.canep.2022.102270] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/19/2022] [Accepted: 09/27/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In France, the national breast cancer screening programme (NBCSP), targeting women aged 50-74 years was rolled out nationwide in 2004. It aims at reducing breast cancer mortality. In addition to the NBCSP, the use of opportunistic screening is permitted in France. The objective of this study is to estimate both opportunistic use and overall coverage rates of breast cancer screening, among women 40-84 years of age, in France. METHODS The French medico-administrative health data system (SNDS) was used to identify women performing an opportunistic or organised mammography screening in France in 2016-2017. RESULTS The two-yearly opportunistic mammography screening is 18 % among women aged 40-84; it is 11 % among women aged 50-74, i.e., the target age range for organised screening, 36 % among women aged 40-49 and 13 % among women aged 75-84. The overall two-yearly screening coverage is 48 % for all women aged 40-84; it is 60 % among women aged 50-74, 36 % among women 40-49 and 16 % for those aged 75-84. Geographical variations in screening are lessened when the two screening strategies are considered, as they balance each other. CONCLUSION Although coverage in the NBCSP is around 50 % in France, more than one third of the women make use of opportunistic screening within and outside the target age range. Organized screening appears to improve equity of access to mammography screening service. The lack of data on opportunistic screening practices hinders the evaluation of French screening practices as a whole.
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Affiliation(s)
- Cécile Quintin
- National public health agency (Santé publique France), 12 rue du Val d'Osne, 94410 Saint Maurice, France.
| | - Edouard Chatignoux
- National public health agency (Santé publique France), 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Julie Plaine
- National public health agency (Santé publique France), 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Françoise F Hamers
- National public health agency (Santé publique France), 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Agnès Rogel
- National public health agency (Santé publique France), 12 rue du Val d'Osne, 94410 Saint Maurice, France
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13
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Guillaume E, Rollet Q, Launay L, Beuriot S, Dejardin O, Notari A, Crevel E, Benhammouda A, Verzaux L, Quertier MC, Launoy G. Evaluation of a mobile mammography unit: concepts and randomized cluster trial protocol of a population health intervention research to reduce breast cancer screening inequalities. Trials 2022; 23:562. [PMID: 35804417 PMCID: PMC9270750 DOI: 10.1186/s13063-022-06480-w] [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: 03/07/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer is the leading cancer in women in France both in incidence and mortality. Organized breast cancer screening (OBCS) has been implemented nationwide since 2004, but the participation rate remains low (48%) and inequalities in participation have been reported. Facilities such as mobile mammography units could be effective to increase participation in OBCS and reduce inequalities, especially areas underserved in screening. Our main objective is to evaluate the impact of a mobile unit and to establish how it could be used to tackle territorial inequalities in OBCS participation. METHODS A collaborative project will be conducted as a randomized controlled cluster trial in 2022-2024 in remote areas of four French departments. Small geographic areas were constructed by clustering women eligible to OBCS, according to distance to the nearest radiology centre, until an expected sample of eligible women was attained, as determined by logistic and financial constraints. Intervention areas were then selected by randomization in parallel groups. The main intervention is to propose an appointment at the mobile unit in addition to current OBCS in these remote areas according to the principle of proportionate universalism. A few weeks before the intervention, OBCS will be promoted with a specific information campaign and corresponding tools, applying the principle of multilevel, intersectoral and community empowerment to tackle inequalities. DISCUSSION This randomized controlled trial will provide a high level of evidence in assessing the effects of mobile unit on participation and inequalities. Contextual factors impacting the intervention will be a key focus in this evaluation. Quantitative analyses will be complemented by qualitative analyses to investigate the causal mechanisms affecting the effectiveness of the intervention and to establish how the findings can be applied at national level. TRIAL REGISTRATION Registered on ClinicalTrials.gov, December 21, 2021: NCT05164874 .
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Affiliation(s)
- Elodie Guillaume
- U1086 INSERM "ANTICIPE" Caen Normandy University - Equipe Labellisée Ligue, Contre le Cancer, Caen, France.
| | - Quentin Rollet
- U1086 INSERM "ANTICIPE" Caen Normandy University - Equipe Labellisée Ligue, Contre le Cancer, Caen, France
| | - Ludivine Launay
- U1086 INSERM "ANTICIPE" Caen Normandy University - Equipe Labellisée Ligue, Contre le Cancer, Caen, France.,Centre de lutte contre le cancer François Baclesse, Caen, France
| | - Séverine Beuriot
- U1086 INSERM "ANTICIPE" Caen Normandy University - Equipe Labellisée Ligue, Contre le Cancer, Caen, France
| | | | | | - Elodie Crevel
- Centre Régional de Coordination des Dépistages des Cancers Normandie, Caen, France
| | - Ahmed Benhammouda
- Centre Régional de Coordination des Dépistages des Cancers Normandie, Caen, France
| | - Laurent Verzaux
- Centre Régional de Coordination des Dépistages des Cancers Normandie, Caen, France
| | | | - Guy Launoy
- U1086 INSERM "ANTICIPE" Caen Normandy University - Equipe Labellisée Ligue, Contre le Cancer, Caen, France.,CHU CAEN, Caen, France
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14
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Deneche I, Touzani R, Bouhnik AD, Rey D, Bendiane MK, Chirpaz E. Factors associated with mammography screening among Reunionese women : a cross-sectional study. Rev Epidemiol Sante Publique 2022; 70:117-122. [PMID: 35491336 DOI: 10.1016/j.respe.2022.03.122] [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: 08/23/2021] [Revised: 03/07/2022] [Accepted: 03/21/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To explore the factors associated with the uptake of mammography screening in Reunionese women aged 50-65 years. METHODS This study included all women aged 50 to 65 years participating in a population-based cross-sectional study "FOSFORE". Participants were recruited between March and June 2017 using two sampling frames. The first frame consisted of households with a landline telephone, with or without a mobile line, by first randomly generating a telephone number and then randomly selecting an individual from among all eligible women in the household. The second sampling frame was constituted of women with an exclusive mobile line, who were selected directly if they met the eligibility criteria. Data were weighted for age and socio-professional status to ensure representativeness at the Reunion Island level. Weighted logistic regression was used to calculate odds ratios while adjusting for confounders. RESULTS 417 women were included in the study; 63.8% were up to date with guidelines on mammography screening and 36.2% were not up to date. Four factors were significantly associated with mammography screening, with an adjusted odds ratio of 2.92 (95% CI 1.51-5.61) for not having an Active Solidarity Income, 1.98 (95% CI 1.22-3.23) for having a regular gynecological follow-up by a physician, 6.53 (95% CI 3.23-13.21) for performing a Pap smear test in the past two years, and 2.07 (95% CI 1.21-3.52) for having an adequate literacy level (HLQ3). CONCLUSION The findings of this study suggest that higher socio-economic status is an indicator of participation in mammography screening in La Réunion, and future educational and intervention programs should target women in deprived areas.
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Affiliation(s)
- Imene Deneche
- Cancer Registry of the Reunion Island, Reunion University Hospital Center, Saint Denis, La Réunion, France.
| | - Rajae Touzani
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Research Units for Social and Economic Sciences of Health and Medical Information Processing, ISSPAM, Equipe CANBIOS Labelled Ligue Contre le Cancer, Marseille, France; Institut Paoli-Calmettes, SESSTIM U1252, Marseille, France
| | - Anne Deborah Bouhnik
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Research Units for Social and Economic Sciences of Health and Medical Information Processing, ISSPAM, Equipe CANBIOS Labelled Ligue Contre le Cancer, Marseille, France
| | - Dominique Rey
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Research Units for Social and Economic Sciences of Health and Medical Information Processing, ISSPAM, Equipe CANBIOS Labelled Ligue Contre le Cancer, Marseille, France
| | - Marc Karim Bendiane
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Research Units for Social and Economic Sciences of Health and Medical Information Processing, ISSPAM, Equipe CANBIOS Labelled Ligue Contre le Cancer, Marseille, France
| | - Emmanuel Chirpaz
- Cancer Registry of the Reunion Island, Reunion University Hospital Center, Saint Denis, La Réunion, France; Methodological Support Unit, Reunion University Hospital Center, Saint Denis, La Réunion, France; Centre for Clinical Investigation (INSERM CIC1410), Saint Pierre, La Réunion, France
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15
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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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16
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Khan JR, Carroll SJ, Coffee NT, Warner-Smith M, Roder D, Daniel M. Associations between breast cancer screening participation and residential area sociodemographic features, geographic accessibility, and features of screening venue location in Greater Sydney, Australia. Prev Med 2021; 153:106774. [PMID: 34450190 DOI: 10.1016/j.ypmed.2021.106774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 08/04/2021] [Accepted: 08/21/2021] [Indexed: 12/09/2022]
Abstract
Breast cancer screening (BCS) participation rates are often suboptimal and vary geographically. Environmental features may influence BCS participation, but few studies have assessed this relationship. This study assessed the associations between BCS participation, residential area sociodemographic characteristics, distance to BCS venue, and venue location attributes. Data for 384,433 women residing in Greater Sydney, Australia, invited to BCS during 2011-2014 were spatially joined to their state suburb (SSC) (n = 800). SSC sociodemographic measures included women's median age, proportion women speaking English at home, full-time employed, and university educated; and proportion dwellings with motor-vehicles. Road network distance was calculated to each BCS venue. BCS venues were coded as co-located with bus-stop, train-station, hospital, general practitioner (GP), and shop. Hot spots were calculated to quantify spatial clustering of BCS participation. Multilevel logistic models were used to estimate the associations between environmental predictors and BCS participation, accounting for SSC-level clustering. BCS participation was 53.9% and spatially clustered. BCS was positively associated with SSC-level median age for women, proportions women speaking English and university educated, and dwellings with motor-vehicles. Distance to venue was inversely associated with BCS. Venue co-location with GP was positively associated and co-location with bus-stop, train-station, and shop, hospital were negatively associated with BCS. Residential sociodemographic features, geographic access, and venue location attributes are associated with BCS participation. These findings implicate the relevance of social and built environmental factors to programmatic aims to raise BCS participation. Additional research on venue location features is required to understand where best to site BCS venues.
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Affiliation(s)
- Jahidur Rahman Khan
- Australian Geospatial Health Laboratory, Health Research Institute, University of Canberra, Canberra, Australian Capital Territory, Australia; School of Health Sciences, University of South Australia, Adelaide, Australia.
| | - Suzanne J Carroll
- Australian Geospatial Health Laboratory, Health Research Institute, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Neil T Coffee
- Australian Geospatial Health Laboratory, Health Research Institute, University of Canberra, Canberra, Australian Capital Territory, Australia; Housing and Healthy Cities Research Group, School of Architecture and Built Environment, University of Adelaide, South Australia, Australia
| | | | - David Roder
- School of Health Sciences, University of South Australia, Adelaide, Australia; Cancer Institute NSW, St Leonards, Sydney, New South Wales, Australia
| | - Mark Daniel
- Australian Geospatial Health Laboratory, Health Research Institute, University of Canberra, Canberra, Australian Capital Territory, Australia; Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia
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17
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Mottram R, Knerr WL, Gallacher D, Fraser H, Al-Khudairy L, Ayorinde A, Williamson S, Nduka C, Uthman OA, Johnson S, Tsertsvadze A, Stinton C, Taylor-Phillips S, Clarke A. Factors associated with attendance at screening for breast cancer: a systematic review and meta-analysis. BMJ Open 2021; 11:e046660. [PMID: 34848507 PMCID: PMC8634222 DOI: 10.1136/bmjopen-2020-046660] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Attendance at population-based breast cancer (mammographic) screening varies. This comprehensive systematic review and meta-analysis assesses all identified patient-level factors associated with routine population breast screening attendance. DESIGN CINAHL, Cochrane Library, Embase, Medline, OVID, PsycINFO and Web of Science were searched for studies of any design, published January 1987-June 2019, and reporting attendance in relation to at least one patient-level factor. DATA SYNTHESIS Independent reviewers performed screening, data extraction and quality appraisal. OR and 95% CIs were calculated for attendance for each factor and random-effects meta-analysis was undertaken where possible. RESULTS Of 19 776 studies, 335 were assessed at full text and 66 studies (n=22 150 922) were included. Risk of bias was generally low. In meta-analysis, increased attendance was associated with higher socioeconomic status (SES) (n=11 studies; OR 1.45, 95% CI: 1.20 to 1.75); higher income (n=5 studies; OR 1.96, 95% CI: 1.68 to 2.29); home ownership (n=3 studies; OR 2.16, 95% CI: 2.08 to 2.23); being non-immigrant (n=7 studies; OR 2.23, 95% CI: 2.00 to 2.48); being married/cohabiting (n=7 studies; OR 1.86, 95% CI: 1.58 to 2.19) and medium (vs low) level of education (n=6 studies; OR 1.24, 95% CI: 1.09 to 1.41). Women with previous false-positive results were less likely to reattend (n=6 studies; OR 0.77, 95% CI: 0.68 to 0.88). There were no differences by age group or by rural versus urban residence. CONCLUSIONS Attendance was lower in women with lower SES, those who were immigrants, non-homeowners and those with previous false-positive results. Variations in service delivery, screening programmes and study populations may influence findings. Our findings are of univariable associations. Underlying causes of lower uptake such as practical, physical, psychological or financial barriers should be investigated. TRIAL REGISTRATION NUMBER CRD42016051597.
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Affiliation(s)
- Rebecca Mottram
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Wendy Lynn Knerr
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Daniel Gallacher
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hannah Fraser
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Lena Al-Khudairy
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Abimbola Ayorinde
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sian Williamson
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Chidozie Nduka
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Olalekan A Uthman
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Samantha Johnson
- University of Warwick Library, University of Warwick, Coventry, West Midlands, UK
| | - Alexander Tsertsvadze
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Christopher Stinton
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sian Taylor-Phillips
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Aileen Clarke
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Rollet Q, Guillaume É, Launay L, Launoy G. Socio-Territorial Inequities in the French National Breast Cancer Screening Programme-A Cross-Sectional Multilevel Study. Cancers (Basel) 2021; 13:cancers13174374. [PMID: 34503184 PMCID: PMC8430540 DOI: 10.3390/cancers13174374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 12/29/2022] Open
Abstract
Simple Summary France implemented a national breast cancer screening programme in 2004, which, despite recommendations, still coexists with opportunistic screening practices. We aimed to study socio-territorial inequities in participation in the 2013–2014 screening campaign, using multilevel models. With a representative sample of 42% of the estimated eligible population, we found that the organized programme does not erase social or territorial inequities in participation. Social inequities, at multiple levels, were found in nearly all départements, whereas territorial inequities seemed more context dependent. The impact of the coexistence with opportunistic screening, beyond any control and evaluation, is adding more risks (over-diagnosis, over-treatment) and leads to underestimating the true coverage of the population, mainly in the wealthiest, therefore leading to an underestimation of the true social gradient in participation. The French breast cancer screening programme needs to evolve to be more efficient in coverage, notably through the reduction of the unfair inequities in participation. Abstract Background. France implemented in 2004 the French National Breast Cancer Screening Programme (FNBCSP). Despite national recommendations, this programme coexists with non-negligible opportunistic screening practices. Aim. Analyse socio-territorial inequities in the 2013–2014 FNBCSP campaign in a large sample of the eligible population. Method. Analyses were performed using three-level hierarchical generalized linear model. Level one was a 10% random sample of the eligible population in each département (n = 397,598). For each woman, age and travel time to the nearest accredited radiology centre were computed. These observations were nested within 22,250 residential areas called “Îlots Regroupés pour l’Information Statistique” (IRIS), for which the European Deprivation Index (EDI) is defined. IRIS were nested within 41 départements, for which opportunistic screening rates and gross domestic product based on purchasing power parity were available, deprivation and the number of radiology centres for 100,000 eligible women were computed. Results. Organized screening uptake increased with age (OR1SD = 1.05 [1.04–1.06]) and decreased with travel time (OR1SD = 0.94 [0.93–0.95]) and EDI (OR1SD = 0.84 [0.83–0.85]). Between départements, organized screening uptake decreased with opportunistic screening rate (OR1SD = 0.84 [0.79–0.87]) and départements deprivation (OR1SD = 0.91 [0.88–0.96]). Association between EDI and organized screening uptake was weaker as opportunistic screening rates and as département deprivation increased. Heterogeneity in FNBCSP participation decreased between IRIS by 36% and between départements by 82%. Conclusion. FNBCSP does not erase socio-territorial inequities. The population the most at risk of dying from breast cancer is thus the less participating. More efforts are needed to improve equity.
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19
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Koïvogui A, Levi S, Finkler M, Lewkowicz S, Gombeaud T, Sabate JM, Duclos C, Benamouzig R. Feasibility of encouraging participation in colorectal cancer screening campaigns by motivating people through the social network, Facebook. Colorectal Dis 2020; 22:1325-1335. [PMID: 32397003 DOI: 10.1111/codi.15121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023]
Abstract
AIM To describe the results of a feasibility phase and the expected results of a new approach to increase the participation rate in a Colorectal Cancer Organized Screening Program (CRCSP) through Facebook awareness messages. METHOD This approach targets people aged 50-74 years, who reside in an urban deprived area and regularly connect to Facebook. The feasibility phase ran over 2 months (December 2018 and January 2019) in six municipalities (Seine-Saint-Denis, France). The full provisional campaign will run over a year. The approach consists of sending electronic awareness messages on the importance of screening for colorectal cancer using a specific Facebook module. Subjects who consent to screening complete a test-kit application form. The eligibility of each subject to participate in screening is determined by a doctor before the kit is sent out. RESULTS A total of 39 900 people were reached by the feasibility phase campaign, and 9200 were able to watch at least one Facebook message/video. Of those, 4450 people logged to learn more about the CRCSP, 298 applied for a test kit, 160 test kit applicants were eligible to participate and the test completion rate was 41.9%. According to these feasibility results, 366 120 targeted people would connect regularly in the tested area, 141 541 of whom would be interested in a specific promotional message posted on Facebook. Requests could be made for 9770 kits, with 5246 people being eligible to participate in screening. The expected test-completion rate is estimated at 42%-89%. This would represent 5%-11% of the tests carried out in the area during the same period by 'classical' CRCSP. CONCLUSION Implementation of the Facebook strategy would significantly improve the rate of participation in the CRCSP by mobilizing people with no previous participation, including younger subjects.
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Affiliation(s)
- A Koïvogui
- CRCDC-IDF, Site de Seine-Saint-Denis, Bondy, France
| | - S Levi
- Medorion Technologies Ltd, Tel Aviv, Israel
| | - M Finkler
- Medorion Technologies Ltd, Tel Aviv, Israel
| | | | - T Gombeaud
- Association de Dépistage du Cancer Colorectal (ADCCR), Clinique d'Hépato-Gastro-Entérologie, Les Lilas, France
| | - J M Sabate
- Service d'Hépato-Gastro-Entérologie, Hôpital Avicenne (AP-HP), Bobigny, France
| | - C Duclos
- Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé (LIMICS), INSERM 1142, Univesité Paris 13, Bobigny, France.,Unité d'Informatique Hospitalière et de Traitement de l'Information Médicale - Service de de Santé Publique, Hôpital Avicenne (AP-HP), Bobigny, France
| | - R Benamouzig
- Service d'Hépato-Gastro-Entérologie, Hôpital Avicenne (AP-HP), Bobigny, France
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20
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Tron A, Caulliez S, Malmartel A. Comparison of mammography results from individual and organized screening for breast cancer. J Gynecol Obstet Hum Reprod 2020; 50:101926. [PMID: 33007526 DOI: 10.1016/j.jogoh.2020.101926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND In France, the coexistence of individual screening (IS) and organized screening (OS) for breast cancer induces difficulties for primary care practitioners to position themselves. This study assessed whether the risk of having a mammography with a high risk of malignancy (BI-RADS 4 or 5) was different between patients aged from 50 to 74year performing it as part of an IS or of the OS. METHOD This cross-sectional multicenter study included women aged 50-74, with no personal history of breast cancer, performing mammography in radiology centers in Paris (France). The nature of the screening (OS or IS), breast cancer risk (high risk: BI-RADS 4 or 5), risk factors and clinical breast examination (CBE) abnormalities were collected. Patients in the IS and OS group were matched on age, breast density, history of benign lesions and family history of breast cancer using a propensity score. The association between the nature of screening and the risk of malignancy was evaluated by conditional logistic regression. RESULTS Among 2190 included patients, 77 % performed a mammography with the IS and had more CBE abnormalities (23 % vs 11 %, p<0,001), a history of benign lesion (15 % vs 11 %, p=0.01) and a family history of breast cancer (42 % vs 29 %, p<0,001). After matching 503 OS patients with 941 IS patients, the risk of malignancy and the nature of the screening were not associated (OR=0.72 [0.35-1.47], p=0.50). CONCLUSION The risk of malignancy was not different whether the mammography was performed as part of the OS or IS.
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Affiliation(s)
- Arthur Tron
- Université de Paris, Faculté de Santé, UFR de Médecine, Département de médecine générale, F-75014, Paris, France.
| | - Ségolène Caulliez
- Université de Paris, Faculté de Santé, UFR de Médecine, Département de médecine générale, F-75014, Paris, France
| | - Alexandre Malmartel
- Université de Paris, Faculté de Santé, UFR de Médecine, Département de médecine générale, F-75014, Paris, France
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21
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National organization of uterine cervical cancer screening and social inequality in France. Eur J Cancer Prev 2020; 29:458-465. [PMID: 32740172 DOI: 10.1097/cej.0000000000000557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Some of the inequality in uterine cervical cancer (UCC) screening uptake are due to the socioeconomic deprivation of women. A national organized screening programme has proven to be effective in increasing the uptake, but may increase socioeconomic inequality. Therefore, we compared inequality in uptake of UCC screening between two French departments, one of which is experimenting an organized screening programme. We used reimbursement data from the main French health insurance scheme to compare screening rates in the municipalities of the two departments over a three-year period. The experimental department had higher screening rates, but the increase in deprivation in municipalities had a greater effect on the decrease in participation in this department. Moreover, while screening rates were higher in urban areas, the negative effect of deprivation on participation was greater in rural areas. Although these departments were compared at the same time under different conditions, socioeconomic inequality between them may have been greater before the experimentation started. However, screening may have led to an increase in socioeconomic inequality between women screened. Special attention must be paid to changes in socioeconomic and geographic inequality in the uptake of UCC screening when the programme is rolled out nationally.
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22
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Padilla CM, Painblanc F, Soler-Michel P, Vieira VM. Mapping Variation in Breast Cancer Screening: Where to Intervene? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2274. [PMID: 31252599 PMCID: PMC6651541 DOI: 10.3390/ijerph16132274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/07/2019] [Accepted: 06/22/2019] [Indexed: 11/24/2022]
Abstract
Small geographic areas with lower mammography screening participation rates may reflect gaps in screening efforts. Our objective was to use spatial analyses to understand disparities in mammography screening use and to identify factors to increase its uptake in areas that need it in Lyon metropolitan area, France. Data for screened women between the ages of 50 and 74 were analyzed. Census blocks of screened and non screened women were extracted from the mammography screening programme 2015-2016 dataset. We used spatial regression models, within a generalized additive framework to determine clusters of census blocks with significantly higher prevalence of non-participation of mammography screening. Smoothed risk maps were crude and adjusted on the following covariates: deprivation index and opportunistic screening. Among 178,002 women aged 50 to 74, 49.9% received mammography screening. As hypothesized, women living in highly deprived census blocks had lower participation rates compared to less deprived blocks, 45.2% vs. 51.4% p < 0.001. Spatial analyses identified four clusters, one located in an urban area and three in suburban areas. Moreover, depending on the location of the cluster, the influence came from different variables. Knowing the impact of site-specific risk factors seems to be important for implementing an appropriate prevention intervention.
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Affiliation(s)
- Cindy M Padilla
- Université Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449 Rennes, France.
| | - François Painblanc
- Université Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449 Rennes, France
| | - Patricia Soler-Michel
- Centre régional de coordination des dépistages des cancers Auvergne Rhône Alpes, 5 bis, rue Cléberg, 69322 Lyon CEDEX 05, France
| | - Veronica M Vieira
- Program in Public Health, University of California, Irvine, CA 92697, USA
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23
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Smith D, Thomson K, Bambra C, Todd A. The breast cancer paradox: A systematic review of the association between area-level deprivation and breast cancer screening uptake in Europe. Cancer Epidemiol 2019; 60:77-85. [PMID: 30927689 PMCID: PMC6547165 DOI: 10.1016/j.canep.2019.03.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 03/05/2019] [Accepted: 03/11/2019] [Indexed: 12/21/2022]
Abstract
Breast cancer rates are lower amongst women from more socio-economically deprived areas. However, their mortality rates are higher. One explanation of this breast cancer paradox is that women from more deprived areas are less likely to attend breast cancer screening programmes. This systematic review is the first to examine this issue in Europe. A systematic review of Embase, Medline and PsychINFO (from 2008 to 2019) was undertaken (PROSPERO registration number: CRD42018083703). Observational studies were included if they were based in Europe, measured breast cancer screening uptake, compared at least two areas, included an area-level measure of socio-economic deprivation and were published in the English language. The Joanna Briggs Institute critical appraisal checklist was used to assess study quality and risk of bias. Thirteen studies from seven different European countries met our inclusion criteria and were included in the review. In ten of the thirteen studies, there was a significant negative association between screening uptake and area-level socio-economic deprivation - with women living in more socio-economically deprived neighbourhoods less likely to attend breast cancer screening. Although universal screening programmes were provided in most studies, there were still strong negative associations between screening uptake and area-level socio-economic deprivation. Future breast cancer screening strategies should acknowledge these challenges, and consider developing targeted interventions in more deprived areas to increase screening participation.
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Affiliation(s)
- Dinah Smith
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle 14 upon Tyne, NE1 7RU, UK
| | - Katie Thomson
- Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Clare Bambra
- Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Adam Todd
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle 14 upon Tyne, NE1 7RU, UK; Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
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