Cervical cancer rates in relation to the Roma population distribution in Slovakia in 2013 – 2020

Abstract

Abstract Background Globally, more than 300 000 women die due to cervical cancer (CC) each year despite its high preventability and treatability in its early stages. This study aimed to analyse CC rates at the regional level in Slovakia from 2013 to 2020 in relation to the distribution of the Roma population. Methods An ecological study was conducted using data obtained from the relevant national and regional authorities in Slovakia. Mortality, incidence, precancerous lesions incidence and the number of colposcopy and oncocytology examinations per 100 000 females 15 years and older were calculated. Linear regression models were performed in the R Project to assess associations between the rates and the estimated percentage of the Roma population at the regional level after adjusting for the unemployment, at-risk-of-poverty rate, and average disposable household income per month. Results CC mortality in Slovakia declined from 10.0 in 2013 to 7.1/100 000 in 2020 (p < 0.05). Average mortality ranged from 5.9 in the Presov region to 10.7 in Kosice. Incidence varied from 108 in 2019 to 160/100 000 in 2017, with the highest average rates in Bratislava and the lowest in Banska Bystrica (194 and 89/100 000). Precancerous lesions incidence rates significantly differed between the regions (400 in Kosice, 984/100 000 in Trnava). The average colposcopy and oncocytology examinations rates were found to be lower in Presov (177 and 226) and Kosice (166 and 223) compared to the other regions (318 and 283/100 000 on average). After adjusting for the selected factors, CC mortality (p < 0.05), incidence (p < 0.05) and both preventive examination rates (p < 0.01) were statistically significantly associated with the percentage of the Roma population. Conclusions Substantial differences in CC rates and preventive examinations were identified at the regional level in Slovakia. To eliminate CC in line with the WHO Global Strategy, suitable approaches to reaching those at the highest risk should be implemented. Key messages • Substantial regional differences in preventive examination and cervical cancer incidence and mortality rates were identified in Slovakia in relation to the distribution of the Roma population. • Strategies to eliminate cervical cancer should be adjusted to the regional differences and seek alternative approaches for implementing screening in hard-to-reach communities at the highest risk.