Never and under cervical cancer screening in Switzerland and Belgium: trends and inequalities

Vladimir Jolidon,Stéphane Cullati,Vincent De Prez,Piet Bracke,Barbara Willems,Claudine Burton-Jeangros

doi:10.1186/s12889-020-09619-z

Vladimir Jolidon, Stéphane Cullati + Show 4 more

Open Access

https://doi.org/10.1186/s12889-020-09619-z

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Abstract

BackgroundResearch on inequalities in cervical cancer screening (CCS) participation has overlooked the distinction between ‘never-’ and ‘under-screeners’ while different socioeconomic and demographic determinants may underlie ‘non-’ and ‘under-’ screening participation. This study examines socioeconomic and demographic inequalities in never and under CCS participation. We compare cross-national prevalence and trends among these two groups in Switzerland and Belgium, two countries with similar opportunistic CCS strategy but different healthcare systems.MethodsData on 38,806 women aged 20–70 from the Swiss Health Interview Survey (1992–2012) and 19,019 women aged 25–64 from the Belgian Health Interview Survey (1997–2013), both population-based cross-sectional nationally representative surveys, was analysed. Weighted adjusted prevalence ratios were estimated with multivariate Poisson regressions.ResultsOver the studied period, never screening prevalence was about 15% in both Switzerland and Belgium and under screening prevalence about 14.0%. Socioeconomic gradients were found among both never- and under-screeners. Higher income women had lower never and under screening prevalence in Switzerland and a similar gradient in education was observed in Belgium. Importantly, distinct socioeconomic and demographic determinants were found to underlie never and under screening participation. Never screening was significantly higher among foreign nationals in both countries and this association was not observed in under screening. Never screening prevalence was lower among older age groups, while under screening increased with older age. Over time, age inequalities diminished among never- and under- screeners in Switzerland while educational inequalities increased among never-screeners in Belgium.ConclusionFindings revealed that determinants of screening inequalities differed among never- and under-screeners and hence these should be addressed with different public health strategies. Crucially, socioeconomic and demographic inequalities were more pronounced among never-screeners who appeared to face more structural and persistent inequalities. Differences between the two countries should also be noted. The more liberal-type Swiss healthcare systems appeared to shape income-related screening inequalities, while education appeared to be a stronger determinant of never- and under-screening in Belgium.

Highlights

IntroductionEurope’s overall incidence rate is 11.2 per 100,000 women per year, in agestandardised rate by world population, and Switzerland and Belgium’s incidence rates are lower than the European average with 3.8 and 7.8 per 100,000, respectively [1]
Cervical cancer (CC) ranks fourth worldwide for both incidence and mortality [1]
Prevalence and trends in never and under cervical cancer screening Over the studied period, never CCS prevalence was 15.8% in Switzerland and 15.0% in Belgium (Table 1)

Summary

Introduction

Europe’s overall incidence rate is 11.2 per 100,000 women per year, in agestandardised rate by world population, and Switzerland and Belgium’s incidence rates are lower than the European average with 3.8 and 7.8 per 100,000, respectively [1]. It was shown that cervical cancer screening (CCS), and organised populationbased CCS, reduces both incidence and mortality [2,3,4]. Western Europe has an average CC incidence rate of 6.8 per 100,000 women, whereas that of Central and Eastern Europe, characterised by lower screening coverage, is of 16.0 per 100,000 [6]. Research on inequalities in cervical cancer screening (CCS) participation has overlooked the distinction between ‘never-’ and ‘under-screeners’ while different socioeconomic and demographic determinants may underlie ‘non-’ and ‘under-’ screening participation. We compare cross-national prevalence and trends among these two groups in Switzerland and Belgium, two countries with similar opportunistic CCS strategy but different healthcare systems

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