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Altová A, Kulhánová I, Reisser K, Netrdová P, Brož J, Eikemo TA, Balaj M, Lustigová M. Educational inequalities in cervical cancer screening participation in 24 European countries. Public Health 2024; 233:1-7. [PMID: 38805834 DOI: 10.1016/j.puhe.2024.04.036] [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: 01/23/2024] [Revised: 04/10/2024] [Accepted: 04/25/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVES Cervical cancer screening (CCS) is an important public health measure for early detection of cervical cancer and prevents a large proportion of cervical cancer deaths. However, participation in CCS is relatively low and varies substantially by country and socio-economic position. This study aimed to provide up-to-date participation rates and estimates on educational inequalities in CCS participation in 24 European countries with population-based CCS programmes. STUDY DESIGN This was a cross-sectional study. METHODS Using data from the European Health Interview Survey (EHIS) conducted in 2019, 80,479 women aged 25-64 years were included in the analyses. First, standardized participation rates and standardized participation rates by educational attainment were calculated for all 24 countries based on each country-specific screening programme organization. Second, a series of generalized logistic models was applied to assess the effect of education on CCS participation. RESULTS Screening participation rates ranged from 34.1% among low-educated women in Romania to 97.1% among high-educated women in Finland. We observed that lower-educated women were less likely to attend CCS than their higher-educated counterparts. Largest educational gaps were found in Sweden (odds ratio [OR] = 6.36, 95% confidence interval [CI] = 3.89-10.35) and Poland (odds ratio = 5.80, 95% CI = 4.34-7.75). CONCLUSION Population-based screening initiatives have successfully reduced participation differences between women with medium and high educational attainment in some countries; however, persistent disparities still exist between women with low and high levels of education. There is an urgent need to increase participation rates of CCS, especially among lower-educated women.
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Affiliation(s)
- A Altová
- Department of Demography and Geodemography, Faculty of Science, Charles University, Albertov 6, Praha 2, 12800, Czech Republic.
| | - I Kulhánová
- Department of Demography and Geodemography, Faculty of Science, Charles University, Albertov 6, Praha 2, 12800, Czech Republic; Department of Social Geography and Regional Development, Faculty of Science, Charles University, Albertov 6, Praha 2, 12800, Czech Republic
| | - K Reisser
- Faculty of Medicine, Leipzig University, Liebigstraße, 04103, Leipzig, Germany; Faculty of Health, Medicine, and Life Sciences, Maastricht University, Minderbroedersberg 4-6, 6211 LK Maastricht, the Netherlands
| | - P Netrdová
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Albertov 6, Praha 2, 12800, Czech Republic
| | - J Brož
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, V Úvalu 84, Praha 5, 150 06, Czech Republic
| | - T A Eikemo
- Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology, Edvard Bulls veg 17049 Trondheim, Norway
| | - M Balaj
- Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology, Edvard Bulls veg 17049 Trondheim, Norway
| | - M Lustigová
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Albertov 6, Praha 2, 12800, Czech Republic; National Institute of Public Health, Šrobárova 49/48, Praha 10, 100 00, Czech Republic
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Ngo O, Chloupková R, Cibula D, Sláma J, Mandelová L, Hejduk K, Hajdúch M, Minka P, Koudeláková V, Jaworek H, Trnková M, Vaněk P, Dvořák V, Dušek L, Májek O. Direct mailing of HPV self-sampling kits to women aged 50-65 non-participating in cervical screening in the Czech Republic. Eur J Public Health 2024; 34:361-367. [PMID: 38224266 PMCID: PMC10990530 DOI: 10.1093/eurpub/ckad229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND A population-based cervical cancer screening programme is implemented in the Czech Republic. However, participation is insufficient among women over 50 years. This study aimed to estimate the potential improvement in participation through directly mailed HPV self-sampling kits (HPVssk) compared with standard invitation letters in women aged 50-65 non-participating in screening. METHODS The study recruited 1564 eligible women (no cervical cancer screening in the last 3 years or more, no previous treatment associated with cervical lesions or cervical cancer). Eight hundred women were mailed with an HPVssk (HPVssk group), and 764 women were sent a standard invitation letter (control group) inviting them to a routine screening (Pap test). The primary outcome was a comparison of the overall participation rate between study groups using a binominal regression model. RESULTS The participation rate in the HPVssk group was 13.4% [95% confidence interval (CI) 11.2-15.9%; 7.4% of women returned the HPVssk and 6.0% attended gynaecological examination] and 5.0% (95% CI 3.6-6.8%) in the control group. Using the binominal regression model, the difference between the groups was estimated as 7.6% (95% CI 5.0-10.2%; P < 0.001). In the HPVssk group, 22% of women who returned HPVssk had a positive result and 70% of them underwent a follow-up examination. CONCLUSIONS Compared with traditional invitation letters, the direct mailing of the HPVssk achieved a significantly higher participation rate, along with a notable HPV positivity rate among HPVssk responders. This approach offers a potentially viable method for engaging women who have not yet attended a cervical screening programme.
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Affiliation(s)
- Ondřej Ngo
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Renata Chloupková
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - David Cibula
- Department of Obstetrics, Gynaecology and Neonatology, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Sláma
- Department of Obstetrics, Gynaecology and Neonatology, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lucie Mandelová
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Karel Hejduk
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marián Hajdúch
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
- Laboratory of Experimental Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Petr Minka
- RBP, Health Insurance Company, Ostrava, Czech Republic
| | - Vladimíra Koudeláková
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
- Laboratory of Experimental Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Hana Jaworek
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
- Laboratory of Experimental Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | | | - Peter Vaněk
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - Vladimír Dvořák
- Centre of Outpatient Gynaecology and Primary Care, Brno, Czech Republic
| | - Ladislav Dušek
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ondřej Májek
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Poniewierza P, Panek G. Cervical Cancer Prophylaxis—State-of-the-Art and Perspectives. Healthcare (Basel) 2022; 10:healthcare10071325. [PMID: 35885852 PMCID: PMC9319342 DOI: 10.3390/healthcare10071325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/28/2022] [Accepted: 07/12/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Each year 604,127 new cases of cervical cancer (CC) are diagnosed, and 341,831 individuals die from the disease. It is the fourth most common cancer among women and the fourth most common cause of death from female cancers worldwide. The pathogenesis of CC is associated with human papillomavirus (HPV) infections and consists of several steps involving cell proliferation outside the human body’s control mechanisms. Strategies to prevent CC are based on screening and vaccination. Scope of the Review: The aim of this paper was to collect and analyze the available literature on the issue of CC prevention and the impact of the COVID-19 pandemic on its implementation. For this purpose, PubMed and Google Scholar databases were searched using keywords, such as “cervical cancer”; “HPV”; “prevention”; “prophylaxis”; “vaccination”; “screening” and “COVID-19” in different variations. Only articles published since 2018 were included in the study. Conclusions: Selected European countries have different CC prevention programs funded by national budgets. This translates into observed differences in the risk of death from CC (age-standardized rate Malta = 1.1, Poland = 5.9). COVID-19 pandemic due to disruption of CC screening may exacerbate these differences in the future. To improve the situation, new screening methods, such as p16/Ki67, HPV self-testing, and the use of artificial intelligence in colposcopic assessment, should be disseminated, as well as free HPV vaccination programs implemented in all countries. The search for new solutions is not without significance and entails ultra-sensitive screening tests for risk groups (mRNA E6/E7, SOX1/SOX14), HPV vaccines with shorter dosing schedules, and new therapeutic pathways using nanotheranostics.
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Affiliation(s)
- Patryk Poniewierza
- Medicover SP ZOO Company, Aleje Jerozolimskie 96, 00-807 Warsaw, Poland
- Correspondence:
| | - Grzegorz Panek
- Department of Oncologic Gynecology and Obstetrics, The Center of Postgraduate Medical Education, 00-416 Warsaw, Poland;
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