Social disparities in breast and cervical cancer preventive practices

Adherence to Screening Tests for Gynaecological and Colorectal Cancer in Patients with Diabetes in Spain: A Population-Based Study (2014-2020)

Objectives: Both diabetes mellitus (DM) and gynaecological and colorectal cancers are highly prevalent diseases. Furthermore, the presence of DM constitutes a risk factor and poor prognostic indicator for these types of cancer. This study is based on the European Health Interview Surveys in Spain (EHISS) of 2014 and 2020. It aimed to determine the trends in adherence to screening tests for gynaecological cancers (breast and cervical) and colorectal cancer, compare adherence levels between populations with and without diabetes, and identify predictors of adherence in the population with diabetes. Methods: An epidemiological case-control study based on the EHISS data of 2014 and 2020 was conducted. The characteristics of participants who underwent screening tests were analysed based on the presence or absence of DM, and predictors of adherence to these preventive activities were identified. Results: A total of 1852 participants with reported DM and 1852 controls without DM, adjusted for age and sex, were included. A higher adherence to mammography was observed in women without diabetes compared to those with diabetes, although statistical significance was not reached (72.9% vs. 68.6%, p = 0.068). Similarly, higher Pap smear adherence was observed in the population without diabetes in the age group between 60 and 69 years compared to the population with diabetes (54.0% vs. 45.8%, p = 0.016). Pap smear adherence among women with diabetes was significantly higher in the EHISS of 2020 (52.0% in 2014 vs. 61.0% in 2020, p = 0.010), as was the case for faecal occult blood testing (13.8% in 2014 vs. 33.8% in 2020, p < 0.001), but it was not significant for mammography (70.4% in 2014 vs. 66.8% in 2020, p = 0.301). Overall, the predictors of adherence to screening tests were older age, history of cancer and higher education level. Conclusions: Adherence levels to cancer screening tests were lower in the population with diabetes compared to those without diabetes, although an improvement in Pap smear and faecal occult blood test adherence was observed in 2020 compared to 2014. Understanding predictors is important to improve adherence rates in the population with diabetes.

Social determinants of mammography screening among women aged 50 to 59, Peru 2015

Breast cancer (BC) screening could reduce its mortality; however, its access is influenced by societal forces. Our objective is to identify the social determinants associated with mammography screening (MS) in women aged 50 to 59 in Peru. In this cross-sectional analysis of the Peruvian Demographic Health Survey, 2015, MS within the past two years was evaluated through self-report. Prevalence for MS was 21.9% [95% CI: 18.9 to 25.1]. The average age was 54 years (s.d.: 2.5). The higher the socioeconomic status, the higher the prevalence of screening (3.2% vs 41.4% in extreme quintiles, p < .001). In the adjusted models, higher socioeconomic status (PR: 5.81, 95% CI: 2.28 to 14.79), higher education level (PR: 2.03, 95% CI: 1.30 a 3,15) and having health insurance from the Ministry of Health (PR: 2.21, 95% CI: 1.28 to 3.82) and EsSalud (PR: 4.37, 95% CI: 2.67 to 7.15), were positively associated with MS. Social inequalities in screening access exist and might translate into inequalities in cancer morbidity and mortality. The Peruvian government urgently needs to improve screening rates in these vulnerable populations.

Barriers to and discourses about breast cancer prevention among immigrant women in Spain: a qualitative study

OBJECTIVES

To identify knowledge, barriers and discourses about breast cancer screening in Spain among female immigrants from low-income countries and native Spanish women from a low socioeconomic class.

DESIGN

Qualitative interview study with thematic analysis interpreted using cultural mediators.

SETTING

Mallorca, Spain.

PARTICIPANTS

Thirty-six in-depth interviews, using cultural mediators, of immigrant women living in Mallorca who were 50-69 years old and were from Maghreb, Sub-Saharan Africa, Eastern Europe, Latin America, China or were native to Spain and from a low socioeconomic class.

RESULTS

We analysed the interviews to assess breast cancer perceptions and beliefs, discourses about breast cancer prevention and barriers to accessing breast cancer prevention programmes. Although the women reported an association of breast cancer with death, they acknowledged the effectiveness of early detection. They also exhibited reluctance to talk about cancer. Discourses about cancer prevention tended to be proactive or fatalistic, depending on the woman's country of origin. For all women, fear of results and lack of time were barriers that limited participation in breast cancer prevention programmes. Language barriers, frequent changes of residence and fear due to status as an irregular (undocumented) immigrant were barriers specific to immigrant women.

CONCLUSIONS

The culture of origin affects whether an immigrant has a fatalistic or proactive approach toward breast cancer screening. Immigrants from low-income countries and Spanish natives from a low socioeconomic class experience barriers in access to breast cancer screening. Frequently changing homes is also a barrier for immigrant women.

Organised population-based programmes and change in socioeconomic inequalities in mammography screening: A 1992-2012 nationwide quasi-experimental study

Organised mammography screening programmes may reduce socioeconomic inequalities in breast cancer screening, but evidence is contradictory. Switzerland has no national organised mammography screening programme, but regional programmes were progressively introduced since 1999, giving the opportunity to conduct a nationwide quasi-experimental study. We examined the evolution of socioeconomic inequalities in mammography screening in Switzerland and if exposure to regional organised programmes reduced socioeconomic inequalities. Data of 10,927 women aged 50 to 70 years old were collected from the Swiss Health Interview Survey, a nationally representative cross-sectional survey repeated 5 times (1992-2012). Socioeconomic characteristics were assessed using education, income, employment status, and occupational class. Adjusted prevalence ratios of up-to-date mammography screening were estimated with Poisson regressions and weighted for sampling strategy and non-participation bias. In the absence of organised screening programmes (1992-1997), prevalence of mammography screening increased by 23% and was associated with tertiary education and working part time. During the period of progressive introduction of regionally organised programmes (2002-2012), prevalence of mammography screening increased by 19% every 5 years and was associated with exposure to regional programmes and with independent/artisan occupations. Tertiary education and working part time were no longer associated. Exposure to organised programmes did not modify socioeconomic inequalities except for employment status: not employed women benefitted more from organised programmes compared to women working full time. In conclusion, socioeconomic inequalities in mammography screening decreased over time but organised programmes did not greatly modify them, except women not employed whose prevalence passed employed women.

Health Promotion Behaviors and Its Predictors Among the College Students in Iran

The health-promoting behaviors form typically during adolescence and youth. This study was conducted to determine the status of the health-promoting behaviors in the students of Babol University of Medical Sciences and its predictors. This cross-sectional study was done on 350 students from April 2016 to July 2016. The applied questionnaires were health-promoting lifestyle profile II, general self-efficacy scale, and sociodemographic variables. Data were analyzed using the SPSS software by descriptive tests, one-way analysis of variance, and multivariable linear regression. The mean total health-promoting lifestyle profile II score was 126.79 ± 19.28. In the subscales, the participants scored the highest in interpersonal relations (24.62 ± 4.59) and the lowest in physical activity (16.53 ± 4.17). Analyses of the data showed that there was a significant association among some subscales of health-promoting behaviors and gender, family size, living in dormitory and also showed that self-efficacy remained as significant factor in relation to all subscales of health-promoting behaviors.

[Prevalence in the performance of mammographies in Spain: Analysis by Communities 2006-2014 and influencing factors]

OBJECTIVE

To determine the frequency of the performance of mammography with preventive purpose of the screening of breast cancer in Spanish women, the evolution between the years 2006-2014, the sociodemographic profile of the women who undergo the mammography and to analyze the factors that influence in their adhesion.

DESIGN

Transversal study.

SITES

Spain.

PARTICIPANTS

A total of 53.628 women over 15 years old that are surveyed in the National Health Survey in Spain 2006 and 2011/12 and the European Health Survey in Spain 2009 and 2014.

MEASUREMENTS

The following variables were used: mammography, frequency of mammography performance and the reason for the realization, as well as sociodemographic variables. Social class was obtained from the last occupation of the main family supporter. A logistic regression analysis was performed with sociodemographic variables.

RESULTS

The prevalence of mammography has been increasing from 2006 to 2014, and also for the reason that the participants had received a letter, they were telephoned or offered in their Health Center to undergo this test. There are significant differences in the performance of mammography in the different autonomous communities.

CONCLUSIONS

Performing mammography has increased significantly from 2006 to 2014, although there are still differences between autonomous communities, with Ceuta and Melilla being the least percentage of performed mammography. The factors that are related to greater performed mammography are: higher educational level, higher social class, married civil status, Spanish nationality and age.

Cervical cancer screening in Switzerland: cross-sectional trends (1992-2012) in social inequalities

Background: Incidence and mortality of cervical cancer declined thanks to Pap smear screening. However cervical cancer screening (CCS) inequalities are documented, including in high income countries. This population-based study aims to assess the importance and 20-year trends of CCS inequalities in Switzerland, where healthcare costs and medical coverage are among the highest in the world. Methods: We analyzed data from five waves of the population-based Swiss Health Interview Survey (SHIS) covering the period 1992–2012. Multivariable Poisson regression were used to estimate weighted prevalence ratios (PR) of CCS and 95% Confidence Intervals (CI) adjusting for socio-economic, socio-demographic characteristics, family status, health status, and use of healthcare. Results: The study included 32’651 women aged between 20 and 70 years old. Between 1992 and 2012, rates of CCS over the past 3 years fluctuated between 71.7 and 79.6% (adjusted P < 0.001). Lower CCS was observed among women with low education, low income, those having limited emotional support, who were non-Swiss, single, older, living in non-metropolitan area or in the French-speaking region, overweight. Over the analyzed period, differences in CCS across age groups diminished while rates among women who visited a GP over the previous year, versus those who did not, increased. Conclusions : While important changes occurred in screening recommendations and in social circumstances of the targeted population, CCS rates remained fairly stable in Switzerland between 1992 and 2012. At the same time, inequalities in CCS persisted over that period.

Health-related Factors Associated with Adherence to Breast Cancer Screening

Introduction:

In Belgium, an effective preventive program for breast cancer exists but as in many countries to few women participates in the screening. This study aims to describe the factors that affect the participation in the national breast cancer screening program.

Methods:

The participants were aged between 50 and 69 years and were recruited during an exhibition at the Brussels Exhibition Centre. Medical history and health-related parameters of the participants were recorded.

Results:

In total, 350 women aged between 50 and 69 years participated. After adjustment for age and region, 81.5% of the participants had a mammography during the past 2 years. The multivariate analysis confirms the association between not having had a mammography and (a) having an older age (odds ratio [OR]: 0.25–0.87), (b) having diabetes (OR: 0.08–0.80), (c) having a family history of coronary heart disease (OR: 0.16–0.80), (d) not following a cholesterol diet or treatment (OR: 0.10–0.91) and (e) having a higher body mass index (OR: 0.39–0.97). Having had a mammogram was associated with adherence to cervical smear screening (OR: 2.74–11.21).

Conclusions:

Most of these associations are most likely related to socioeconomic status. However, the relationship with diabetes offers opportunities to increase the participation in breast cancer screening programs because these patients have regular contacts with their family physicians.

Breast cancer screening attendance in two Swiss regions dominated by opportunistic or organized screening

BACKGROUND

In Switzerland, the French-speaking region has an organized breast cancer (BC) screening program; in the German-speaking region, only opportunistic screening until recently had been offered. We evaluated factors associated with attendance to breast cancer screening in these two regions.

METHODS

We analyzed the data of 50-69 year-old women (n = 2769) from the Swiss Health Survey 2012. Factors of interest included education level, place of residence, nationality, marital status, smoking history, alcohol consumption, physical activity, diet, self-perceived health, history of chronic diseases and mental distress, visits to medical doctors and cervical and colorectal cancer screening. Outcome measures were dichotomized into ≤2 years since most recent mammography versus >2 years or never.

RESULTS

In the German- and French-speaking regions, mammography attendance within the last two years was 34.9 % and 77.8 %, respectively. In the French region, moderate alcohol consumption (adjusted OR 2.01, 95 % CI 1.28-3.15) increased screening attendance. Compared to those with no visit to a physician during the recent year, women in both regions with such visits attended statistically significantly more often BC screening (1-5 times vs. no visit: German (adjusted OR 3.96, 95 % CI 2.58-6.09); French: OR 7.25, 95 % CI 4.04-13.01). Non-attendance to cervical screening had a negative effect in both the German (adjusted OR 0.44, 95 % CI 0.25-0.79) and the French region (adjusted OR 0.57, 95 % CI 0.35-0.91). The same was true for colorectal cancer screening (German (adjusted OR 0.66, 95 % CI 0.52-0.84); French: OR 0.52, 95 % CI 0.33-0.83). No other factor was associated with BC screening and none of the tests of interaction comparing the two regions revealed statistically significant results.

CONCLUSION

The effect of socio-demographic characteristics, lifestyle, health factors and screening behavior other than mammography on non-attendance to BC screening did not differ between the two regions with mainly opportunistic and organized screening, respectively, and did not explain the large differences in attendance between regions. Other potential explanations such as public promotion of attendance for BC screening, physicians' recommendations regarding mammography participation or women's beliefs should be further investigated.

Social Capital as a Determinant of Self-Rated Health in Women of Reproductive Age: A Population-Based Study

Introduction:

Recognition of the factors related to women’s health is necessary. Evidence is available that the social structure including social capital plays an important role in the shaping people’s health. The aim of the current study was to investigate the association between self-rated health and social capital in women of reproductive age.

Methods:

This study is a population-based cross-sectional survey on 770 women of reproductive age, residing in any one of the 22 municipality areas across Tehran (capital of Iran) with the multi stage sampling technique. Self-rated health (Dependent variable), social capital (Independent variable) and covariates were studied. Analysis of data was done by one-way ANOVA test and multiple linear regressions.

Results:

Depending on logistic regression analyses, the significant associations were found between self-rated health and age, educational level, crowding index, sufficiency of income for expenses and social cohesion. Data show that women with higher score in social cohesion as an outcome dimension of social capital have better self-rated health (PV = 0.001).

Conclusion:

Given the findings of this study, the dimensions of social capital manifestations (groups and networks, trust and solidarity, collective action and cooperation) can potentially lead to the dimensions of social capital outcomes (social cohesion and inclusion, and empowerment and political action). Following that, social cohesion as a dimension of social capital outcomes has positively relationship with self- rated health after controlling covariates. Therefore, it is required to focus on the social capital role on health promotion and health policies.

Social disparities in access to breast and cervical cancer screening by women living in Spain

OBJECTIVES

To describe uptake of breast and cervical cancer screening by women living in Spain, analyse the possible associated social and health factors, and compare uptake rates with those obtained in previous surveys.

STUDY DESIGN

Cross-sectional study using data from the 2011 Spanish national health survey.

METHODS

Uptake of breast cancer screening was analysed by asking women aged 40-69 years whether they had undergone mammography in the previous two years. Uptake of cervical cancer screening was analysed by asking women aged 25-65 years whether they had undergone cervical cytology in the previous three years. Independent variables included sociodemographic characteristics, and variables related to health status and lifestyle.

RESULTS

Seventy-two percent of women had undergone mammography in the previous two years. Having private health insurance increased the probability of breast screening uptake four-fold [odds ratio (OR) 3.96, 95% confidence interval (CI) 2.71-5.79], and being an immigrant was a negative predictor for breast screening uptake. Seventy percent of women had undergone cervical cytology in the previous three years. Higher-educated women were more likely to have undergone cervical cancer screening (OR 2.59, 95% CI 1.97-3.40), and obese women and women living in rural areas were less likely to have undergone cervical cancer screening. There have been no relevant improvements in uptake rates of either breast or cervical cancer screening since 2006.

CONCLUSION

Uptake of breast and cervical cancer screening could be improved in Spain, and uptake rates have stagnated over recent years. Social disparities have been detected with regard to access to these screening tests, indicating that it is necessary to continue researching and optimizing prevention programmes in order to improve uptake and reduce these disparities.

Barriers on Breast Cancer Early Detection Methods

OBJECTIVE

Breast cancer is the most common type of cancer in women throughout the world. It is the second leading cause of cancer related deaths, after lung cancer. Breast cancer is the most common cancer in women in Turkey with a rate of 23,4%. One out of every four women has breast cancer. This study was conducted to determine the barriers on methods of early diagnosis of breast cancer.

MATERIALS AND METHODS

The research population consisted of women over the age of 40 years who live in the neighborhood of Doğanlar (N=2404). The sample size was determined (n=251) with Epi İnfo Statcalc account program with 95% confidence interval, with the incidence of breast cancer accepted as 24%. Women over the age of 40 years who agreed to participate were included in the study. In order to collect the necessary data, a 27-item questionnaire including socio-demographic characteristics and methods of early diagnosis was created according to the literature. This study was conducted between March-October 2012 in Doğanlar neighborhood.

RESULTS

Two-hundred-fifty-four women participated in the study, with a mean age of 54,27±1, and an average monthly income of 895,0197 TL (min=0 TL, max=7000 TL). 79,1% were married, 89,8% were housewives, 56,7% were literate, and 83,1% had health insurance. The status of performing regular Breast Self Examination (BSE) was significantly higher in women who had knowledge about BSE, (p=0.000). Married (p=0.015) women and those who had a social security system (p=0.048) had significantly higher rates of mammography. Women who were informed on mammography (p=0.000) had significantly higher rates of mammography. When reasons for not getting mammography was addressed, it was observed that 99,2% was due to lack of information and education. Women who had regular BSE had significantly higher Clinical Breast Examination (CBE) (p=0.024). Women's sociodemographic characteristics did not affect the status of performing regular BSE and CBE significantly.

CONCLUSION

Barriers against implementation of breast cancer screening methods in women were related to level of education and lack of adequate information about breast cancer screening, and symptoms of breast cancer. Women's lack of information about signs, symptoms and treatment in the early stages of breast cancer needs to be eliminated. Health care providers may have a key role in increasing breast cancer early detection rates.

Female preventive practices: breast and smear tests

Breast cancer and cervical cancer are the most common female cancers in Spain and in many developed countries. The main goal of this paper is to identify the determinants of individual decisions on breast screening and smear testing, that is to say, the decision to take a test for the first time and the decision to test with suitable regularity. To that end, we have combined analyses of micro and macro data (the Spanish National Health Survey and Spanish Regional Social Indicators) and employed multilevel estimation models. Among the main results, we highlight the fact that regional public screening programmes improve individual decisions on screening (more women testing for the first time and more women testing regularly) and, furthermore, they generate positive synergies; for example, regional public programmes for smear testing improve individual decisions on both cervical and breast cancer screening. In addition, we conclude that it is not only important to know if the numbers of women undergoing breast screening and smear testing are increasing, it is also important to know if they are testing regularly.

Social capital in association with health status of women in reproductive age: study protocol for a sequential explanatory mixed methods study

BACKGROUND

Women's health is a general health priority. Preserving and improving women's health is not only a basic human right, but it is also essential for the health of all nations. Women's health in Reproductive age affects long-term health of theirs, their family members, and community. Origins of health inequalities are very complicated. Health outcomes are influenced by biological, social and political factors, so to improve women's health it is necessary to recognize all these factors. Social capital is one of the social determinants of health that might play a considerable role in health inequalities. The association between social capital and health varies according on the sample studied, the type of health outcome and the context in which it is studied. This mixed methods study was designed to determine and explore of relationship between social capital and health status of women of reproductive age in Tehran (capital city of Iran) with its specific social-cultural characteristics.

METHODS/DESIGN

This study is sequential explanatory mixed methods study, follow-up explanations variant, with two strands (phases). This design will be implemented in two distinct phases. The first phase is a population-based cross-sectional survey on 770 women of reproductive age residing in any of the 22 municipal districts across Tehran. Based on a need to further understand the quantitative results, researchers will implement a second qualitative phase that is designed to help explain the initial quantitative results. Finally, the researchers will present an interpretation about explanation of quantitative results using the qualitative data.

DISCUSSION

This study promotes women's health by determining the priorities and designing evidence-based interventions founded on the basic and insightful information provided on social capital and the status of the health of women.

Psychosocial factors and attendance at a population-based mammography screening program in a cohort of Swedish women

Background

A better understanding of the factors that influence mammography screening attendance is needed to improve the effectiveness of these screening programs. The objective of the study was to examine whether psychosocial factors predicted attendance at a population-based invitational mammography screening program.

Methods

Data on cohabitation, social network/support, sense of control, and stress were obtained from the Malmö Diet and Cancer Cohort Study and linked to the Malmö mammography register in Sweden. We analyzed 11,409 women (age 44 to 72) who were free of breast cancer at study entry (1992 to 1996). Mammography attendance was followed from cohort entry to December 31, 2009. Generalized Estimating Equations were used to account for repeated measures within subjects. Adjusted odds ratios (OR) and 95% confidence intervals (CI) are reported.

Results

Among 69,746 screening opportunities there were 5,552 (8%) cases of non-attendance. Higher odds of non-attendance were found among women who lived alone (OR = 1.47 (1.33-1.63)) or with children only (OR = 1.52 (1.29-1.81)), had one childbirth (OR = 1.12 (1.01-1.24)) or three or more childbirths (OR = 1.34 (1.21-1.48)), had low social participation (OR= 1.21 (1.10-1.31)), low sense of control (OR = 1.12 (1.02-1.23)), and experienced greater stress (OR = 1.24 (1.13-1.36)).

Conclusions

Public health campaigns designed to optimize mammography screening attendance may benefit from giving more consideration of how to engage with women who are less socially involved.

Changes in the magnitude of social inequality in the uptake of cervical cancer screening in Taiwan, a country implementing a population-based organized screening program

INTRODUCTION

We sought to examine changes in the magnitude of social inequality in the uptake of cervical cancer screening between 2001 and 2009 in Taiwan.

METHODS

We used data from the 2001 and 2009 Taiwan National Health Interview Surveys to calculate the absolute (slope of index of inequality, SII) and relative (relative index of inequality, RII) summary measures of social inequality in the uptake of Pap smear tests to indicate the magnitude of social inequality.

RESULTS

The prevalence of having had a Pap smear during the previous 3 years increased in each age and socioeconomic group from 2001 to 2009. The SII and RII by urbanization and education level decreased significantly, while the SII and RII by income level increased significantly between the two study years. The largest increase in inequality of prevalence from 2001 to 2009 was between women living in suburban and rural areas with highest income level and women live in metropolitan areas with lowest income level.

CONCLUSIONS

The changes in magnitude of social inequality in the uptake of cervical cancer screening differed by indicators of socioeconomic position. Further studies are needed to explore the mechanisms that result in social inequality by different indicators of socioeconomic position.

Cytology use for cervical cancer screening in Portugal: results from the 2005/2006 National Health Survey

BACKGROUND

Understanding the patterns of cervical cytology use in preventive care may provide useful information for an efficient transition from opportunistic screening to organized programmes. We aimed to identify the determinants of non-use and underuse of cervical cytology in Portuguese women.

METHODS

As part of the fourth National Health Survey (2005/2006), 2191 women aged between 25 and 64 years were evaluated. The previous use of cervical cytology was classified as never or ever, and, among the latter, those having performed the latest cytology testing >5 years before were considered to underuse cervical cytology. We assessed the determinants of non-use and underuse through age- and education-adjusted odds ratios (ORs) and corresponding 95% confidence intervals (95% CIs).

RESULTS

Overall, 23.5% of women had never used cervical cytology and 10.7% reported underuse. This prevalence increased with age and decreased with education and income. Compared with the national mean, the lowest risk of non-use and underuse was observed in Norte (non-use: OR = 0.31, 95% CI: 0.23-0.42; underuse: OR = 0.60, 95% CI: 0.40-0.91) and the highest in Alentejo (non-use: OR = 2.33, 95% CI: 1.78-3.06; underuse: OR = 2.37, 95% CI: 1.43-3.93). Women without a private health insurance (OR = 2.65, 95% CI: 1.29-5.47), who had no doctor appointments in the preceding 3 months (OR = 2.06, 95% CI: 1.22-3.48) and those who had never performed a mammography (OR = 17.78, 95% CI: 9.09-34.78) were more likely to have never performed a cervical cytology.

CONCLUSION

This study shows inequalities in the use of cervical cancer screening in Portugal and provides useful information for a better allocation of resources for cancer screening.

Prevalence and determinants of cervical cytology use in an urban sample of Portuguese women

Understanding local patterns of opportunistic uptake of cervical cancer screening provides important baseline information for an efficient transition to organized screening. The objectives of this study were to estimate the prevalence of cervical cytology use at different intervals and to quantify its associated factors in an urban Portuguese population under no organized cervical cancer screening. As part of the first follow-up evaluation of a cohort of adult dwellers from Porto, 1032 women were evaluated between 2005 and 2008. Lifetime use and age at first cervical cytology, frequency of testing, socioeconomic factors, clinical history, and usual source of care were assessed using a structured questionnaire. Age-adjusted and education-adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for nonuse and underutilization (over 5 years interval between tests) of cervical cytology were computed by unconditional logistic regression. Life prevalence of cervical cytology testing was 91.2%. Among ever-users, 6.7% were screened at 3-year to 5-year intervals and the prevalence of underuse was 21.4%. Older women (≥70 vs. 30-39 years) were more likely to have never been screened (OR = 32.20, 95% CI: 4.17-248.68) and more prone to underuse (OR = 25.49, 95% CI: 6.89-94.30). Underuse was less likely in the more educated (9-12 vs. 0-3 years, OR = 0.21, 95% CI: 0.08-0.52) and in women receiving private health care (private doctor vs. public health care center, OR = 0.28, 95% CI: 0.12-0.65). In conclusion, under opportunistic screening, the high life prevalence of cervical cytology use hides a small proportion of women tested at the recommended intervals and inequalities in access to and frequency of screening.

Changes in the social gradients for Pap smears and mammograms in Argentina: evidence from the 2005 and 2009 National Risk Factor Surveys

OBJECTIVES

To identify changes in the social gradients for Pap smears and mammograms in Argentina.

STUDY DESIGN

Secondary analysis of the 2005 and 2009 Argentine National Risk Factor Surveys.

METHODS

Logistic regression analysis was used to examine social gradients by income and education, adjusting for age and health insurance.

RESULTS

The proportion of women who received a Pap smear in the previous 2 years increased from 51.6% in 2005 to 60.5% in 2009 (χ(2) = 344.8, P < 0.001). A significant increase was also seen in the receipt of a mammogram in the previous 2 years by women aged ≥50 years, with an increase from 39.6% in 2005 to 52.6% in 2009 (χ(2) = 279.6, P < 0.001). In 2005, low-income women were most likely not to have received a Pap test [odds ratio (OR) = 3.27, 95% confidence interval (CI) = 2.70-3.98], followed by medium-income women (OR = 1.73, 95% CI = 1.41-2.12), compared with high-income women. The gradient by education was of a similar magnitude, and both income and education gradients remained stable from 2005 to 2009. Restricting the analysis to eight provinces that have been deemed to be high priority due to their high levels of mortality from cervical cancer reveals an increasing income-based gradient in Pap smears. In contrast, inequalities in mammography diminished across the country, with a significant reduction in the social gradient measured either by income or education. In contrast to high-income women, low-income women experienced higher odds of not having a mammogram, but the gap diminished over time [OR = 4.14 (95% CI = 2.96-5.78) in 2005 vs OR = 2.37 (95% CI = 1.81-3.11) in 2009].

CONCLUSION

Social gradients in cancer screening are changing in Argentina. There are signs of a reduction in inequalities in mammograms, although this is attenuated by indications that inequalities in Pap smear utilization in priority provinces are growing. Surveillance of population indicators is needed to verify whether these short-term changes persist over time.

Sociodemographic determinants of nonattendance in a population-based mammography screening program in the city of Manisa, Turkey

Objectives. Community based breast cancer screening has decreased breast cancer mortality in women. This study examined the predictors of nonattendence for invitational breast cancer screening in relation to socioeconomic status in the city of Manisa, in western Turkey. Study Design. For the evaluation of the reasons for refusing to participate in the study, two districts were selected. 446 women aged between 50 and 69 years were selected from the program database by systematic random sampling. Methods. The questionnaire consisted of sociodemographic variables and the adapted version of Champion's Health Belief Model Scale. Univariete and multivariete logistic regression analysis were performed throughout the data analysis. Results. Being from an urban district and being from the western region were the risk factors for not participating in the screening program (P = 0.014, P = 0.023). A statistical significance was found between mammography-benefit, mammography-barrier and program participation (P = 0.044, P = 0.006). Although there were many more barriers for not participating in the screening program for the women of the slum district, the attendence rate of the slum district was higher than that of the urban district. Conclusions. Increased attendance may be achieved through enhancement of breast cancer awareness and by reducing some of the modifiable barriers.

Inequalities in cervical cancer screening for women with or without a regular consulting in primary care for gynaecological health, in Paris, France

OBJECTIVES

To describe the individual characteristics associated with the absence of cervical smear (CCST); to investigate the role of residential neighbourhood, particularly practitioner density; and to explore changes in individual and contextual determinants after taking regular consulting in primary care for gynaecological health (RCGH) into account.

DATA

1843 adult women from the SIRS survey conducted in 2005 in the Paris metropolitan area. Multilevel logistic regressions analysed factors associated with never-screening.

RESULTS

10% of the women had never undergone CCST. Being single, less educated, of foreign origin, with no children, and without health insurance, having never worked, having never undergone a serious health problem and/or having nobody in their circle with cancer were associated with no CCST. Once adjusted on individual characteristics, living in a middle- (OR=1.95; IC=1.05-3.62) or in a lower-class neighbourhood (OR=2.31; IC=1.26-4.25) was associated with increased risks of never-screening, but neighbourhood physician density was not. Interactions were found between socioeconomic status and RCGH. Individual- and neighbourhood-level associations with CCST were different for women with or without an RCGH.

CONCLUSION

This study analysed individual and contextual inequalities in CCST practice in the Paris metropolitan area. To benefit from an RCGH did not seem to reduce all the social inequalities in CCST practice.

Adherence to breast and cervical cancer screening in Spanish women with diabetes: associated factors and trend between 2006 and 2010

AIM

This study aimed to assess the adherence to breast and cervical cancer screening of women with diabetes mellitus (DM), and the associated factors and trend of use over time of these preventative services between 2006 and 2010 in Spain.

METHODS

The study used data from a population of women aged greater or equal to 18 years (n=11,957) who participated in the European Health Interview Survey in Spain (EHISS, 2009). Diabetes status was self-reported and included those with type 2 DM. Adherence to screening for cancer prevention was assessed by asking women aged greater or equel to 40 years whether they had undergone mammography and a Papanicolaou (Pap) cervical smear (in those aged 18-69 years) within the previous 2 and 3 years, respectively. Independent variables included sociodemographic and health-related characteristics. Also, the age-standardized prevalences of mammography and Pap smear uptake were compared in women with diabetes between 2006 and 2010.

RESULTS

Among the diabetic women, 37.9% underwent mammography and 49.1% had a Pap smear vs 53.8% and 64%, respectively, in women without diabetes, with corresponding adjusted odds ratios of 0.81 (95% CI: 0.68-0.97) and 0.74 (95% CI: 0.60-0.91). Among diabetic women, attending more "physician visits" was a positive predictor of having both screening tests. Also, a higher monthly income level was associated with mammography uptake, and a higher educational level with Pap smear uptake. There was also a significant decrease in mammography screening uptake between 2006 and 2010 compared with a stable rate of uptake of cervical cancer screening.

CONCLUSION

Spanish women with diabetes consistently underuse breast and cervical cancer screening tests compared with non-diabetic women. The decline in mammography uptake rates needs to be carefully monitored and may even call for intervention.

Predictors of low cervical cancer screening among immigrant women in Ontario, Canada

BACKGROUND

Disparities in cervical cancer screening are known to exist in Ontario, Canada for foreign-born women. The relative importance of various barriers to screening may vary across ethnic groups. This study aimed to determine how predictors of low cervical cancer screening, reflective of sociodemographics, the health care system, and migration, varied by region of origin for Ontario's immigrant women.

METHODS

Using a validated billing code algorithm, we determined the proportion of women who were not screened during the three-year period of 2006-2008 among 455,864 identified immigrant women living in Ontario's urban centres. We created eight identical multivariate Poisson models, stratified by eight regions of origin for immigrant women. In these models, we adjusted for various sociodemographic, health care-related and migration-related variables. We then used the resulting adjusted relative risks to calculate population-attributable fractions for each variable by region of origin.

RESULTS

Region of origin was not a significant source of effect modification for lack of recent cervical cancer screening. Certain variables were significantly associated with lack of screening across all or nearly all world regions. These consisted of not being in the 35-49 year age group, residence in the lowest-income neighbourhoods, not being in a primary care patient enrolment model, a provider from the same region, and not having a female provider. For all women, the highest population-attributable risk was seen for not having a female provider, with values ranging from 16.8% [95% CI 14.6-19.1%] among women from the Middle East and North Africa to 27.4% [95% CI 26.2-28.6%] for women from East Asia and the Pacific.

CONCLUSIONS

To increase screening rates across immigrant groups, efforts should be made to ensure that women have access to a regular source of primary care, and ideally access to a female health professional. Efforts should also be made to increase the enrolment of immigrant women in new primary care patient enrolment models.

Trends in socioeconomic disparities in organized and opportunistic gastric cancer screening in Korea (2005-2009)

BACKGROUND

A growth of consensus and increasing activities related to organized cancer screening programs has occurred in Korea since 1999. It is important to assess disparities in the fight against cancer, and it is crucial to identify particular groups that may be experiencing a high burden of cancer-related illness.

METHODS

Data from 8,160 men and women ages >40 years from the 2005 to 2009 Korean National Cancer Screening Survey were used to analyze the relationship between socioeconomic position and receiving upper gastrointestinal series or upper endoscopy within the past 2 years. We used absolute and relative concentration indexes, that is, summary measures of disparity based on both rate differences and rate ratios.

RESULTS

For organized screening, the education disparity declined, but the income disparity index increased, indicating that participation in organized screening was relatively more concentrated among the lower-income groups. For opportunistic screening, income and education disparities increased due to the widening of socioeconomic differences.

CONCLUSIONS

The results of this study suggested progress toward socioeconomic disparity-related goals in organized screening for gastric cancer. However, the income disparity trends in organized screening may change in a manner similar to those in opportunistic screening in the future because of the much faster rate of organized screening uptake by those higher on the socioeconomic scale.

IMPACT

This study addresses the routine monitoring of coverage of screening among different socioeconomic groups and could be used to inform policies to reduce disparity in coverage.

Reducing disparities in mammography-use in a multicultural population in Israel

Background

In the past mammography-use has been reported to be low in Israel compared to other western countries. The objectives of this study were (1) to assess the increase in mammography-use during the years 2002 to 2007 in four population groups in Maccabi Healthcare Services (MHS), Israel: non-immigrant non-ultraorthodox, ultraorthodox, and immigrant Jewish women and Arab women; (2) to assess ethnic and socioeconomic disparities in mammography-use.

Methods

A random telephone survey of 1,550 women receiving healthcare services from MHS was performed during May-June 2007. Information from MHS claims-records database regarding mammography-use was obtained for each woman for the period 2002 to 2007. Since mammography-use serves as a quality assurance measure for primary care, MHS sent mail and telephone invitations for mammography to all women since the end of 2004.

Results

At the beginning of the follow-up period (2002) mammography-use among Jewish non-immigrant non-ultraorthodox and ultraorthodox women was higher than among Arab and Jewish immigrant women. During the 5 year follow-up these disparities decreased significantly. In 2007, mammography-use by Arab women was only slightly lower compared to all groups of Jewish women. In 2007, after adjustment for socioeconomic factors there was only a borderline significant difference between Jewish and Arab women. The socioeconomic variables were not associated with mammography-use in 2002 and 2007 in any of the groups except for marital status in immigrant women in 2002.

Conclusion

The interventions implemented by MHS may have increased mammography-use in all population groups, decreasing disparities between the groups, however the differences between Jewish and Arab women have not been completely eliminated and indicate a need for further targeted interventions. No significant socioeconomic disparities in mammography-use were observed.

Suboptimal rates of cervical testing among women with inflammatory bowel disease

BACKGROUND & AIMS

Women with IBD have a high incidence of abnormal cervical cytology. However, little is known about how frequently women with IBD are tested for cervical abnormalities. We aimed to determine cervical testing rates among women with IBD, specifically those on immunosuppressant medications, and to identify risk factors associated with low incidence of screening.

METHODS

With the PharMetrics Patient-Centric Database from 1996-2005, we identified cases of IBD and matched controls via a validated algorithm. With logistic regression, we compared utilization of cervical testing with IBD case status, patients' age, use of immunosuppressive medications, Medicaid insurance status, and use of primary care services.

RESULTS

Only 70.4% of women with IBD (n = 9356) and 65.2% of matched controls (n = 25,849) received cervical testing (at least once every 3 years). Women with IBD who used primary care services had increased odds of cervical testing (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.19-1.59). Factors associated with reduced testing included Medicaid insurance (OR, 0.28; 95% CI, 0.19-0.41), immunosuppressant medication use (OR, 0.81; 95% CI, 0.74-0.88), and increased age (P for trend < .01). Among women on immunosuppressive medications (n = 7415), 50.1% were tested during a 15-month period. Women on immunosuppressive medications who used primary care services have improved odds of cervical testing (OR, 1.28; 95% CI, 1.14-1.45), whereas those with Medicaid insurance had reduced odds (OR, 0.54; 95% CI, 0.39-0.74).

CONCLUSIONS

Women with IBD are tested for cervical abnormalities at suboptimal rates. Quality improvement initiatives are needed to improve disease prevention services for women with IBD.

Determinants of non attendance to mammography program in a region with high voluntary health insurance coverage

Background

High participation rates are needed to ensure that breast cancer screening programs effectively reduce mortality. We identified the determinants of non-participation in a public breast cancer screening program.

Methods

In this case-control study, 274 women aged 50 to 64 years included in a population-based mammography screening program were personally interviewed. Socio-demographic characteristics, health beliefs, health service utilization, insurance coverage, prior mammography and other preventive activities were examined.

Results

Of the 192 cases and 194 controls contacted, 101 and 173, respectively, were subsequently interviewed. Factors related to non-participation in the breast cancer screening program included higher education (odds ratio [OR] = 5.28; 95% confidence interval [CI95%] = 1.57–17.68), annual dental checks-ups (OR = 1.81; CI95%1.08–3.03), prior mammography at a private health center (OR = 7.27; CI95% 3.97–13.32), gynecologist recommendation of mammography (OR = 2.2; CI95%1.3–3.8), number of visits to a gynecologist (median visits by cases = 1.2, versus controls = 0.92, P = 0.001), and supplemental private insurance (OR = 5.62; CI95% = 3.28–9.6). Among women who had not received a prior mammogram or who had done so at a public center, perceived barriers were the main factors related to non-participation. Among women who had previously received mammograms at a private center, supplemental private health insurance also influenced non-participation. Benign breast symptoms increased the likelihood of participation.

Conclusion

Our data indicate that factors related to the type of insurance coverage (such as prior mammography at a private health center and supplemental private insurance) influenced non-participation in the screening program.

[Which factors influence screening practices for female cancer in France?]

BACKGROUND

The two aims of the study were, first to estimate the declared two-year coverage of breast cancer and cervical cancer screenings, and second to determine the main factors influencing female cancer screening behaviors.

METHODS

Three groups of women from the 2003 French decennial health interview survey were analyzed: 3378 women aged 50-74 years who answered the question on mammography use, 7912 women aged 25-65 years who answered the question on Pap-smear use, and 2528 women aged 50-65 years who answered both questions.

RESULTS

The declared coverage of breast cancer screening was 71.2%, the declared coverage of cervical cancer screening was 76.3%. Almost 18% of women declared having undergone neither a mammography nor a Pap-smear in the last two years. The main factor linked to a more frequent practice of one or both cancer screenings (breast or cervix) was to have undergone recently the other screening. The other factors linked to mammography use were mainly healthcare and practitioner access variables. Those linked to Pap-smear use were mainly socioeconomic and socio-demographic variables, healthcare and practitioner access variables being also linked. The main factors linked to having undergone none of these two screenings were of financial nature, particularly household income and home ownership.

CONCLUSION

The study showed that it is appropriate to communicate on both screenings at the same time since they have a positive effect each other. Finally, practitioners continue to play a central role in collecting information on cancer screenings and encouraging screening in women not regularly screened.