Cancer Screening In Spain Research Articles

Intersectional analysis of inequalities in self-reported breast cancer screening attendance using supervised machine learning and PROGRESS-Plus framework.

Breast cancer is a critical public health concern in Spain, and organized screening programs have been in place since the 1990s to reduce its incidence. However, despite the bi-annual invitation for breast cancer screening (BCS) for women aged 45-69, significant attendance inequalities persist among different population groups. This study employs a quantitative intersectional perspective to identify intersectional positions at risk of not undergoing breast cancer screening in Spain. Women were selected from the 2020 European Health Interview Survey in Spain, which surveyed the adult population (> 15 years old) living in private households (N = 22,072; 59% response rate). Inequality indicators based on the PROGRESS-Plus framework were used to disentangle existing social intersections. To identify intersectional groups, decision tree models, including classification and regression trees (CARTs), chi-squared automatic interaction detector (CHAID), conditional inference rees (CITs), and C5.0, along with an ensemble algorithm, extreme gradient boosting (XGBoost), were applied. XGBoost (AUC 78.8%) identified regional differences (Autonomous Community) as the most important factor for classifying BCS attendance, followed by education, age, and marital status. The C5.0 model (balanced accuracy 81.1%) highlighted that the relative importance of individual characteristics, such as education, marital status, or age, for attendance differs based on women's place of residence and their degree of interaction. The highest risk of not attending BCS was observed among illiterate older women in lower social classes who were born in Spain, were residing in Asturias, Cantabria, Basque Country, Castile and León, Extremadura, Galicia, Madrid, Murcia, La Rioja, or Valencian Community, and were married, divorced, or widowed. Subsequently, the risk of not attending BCS extends to three other groups of women: women living in Ceuta and Melilla; single or legally separated women living in the rest of Spain; and women not born in Spain who were married, divorced, or widowed and not residing in Ceuta or Melilla. The combined use of decision trees and ensemble algorithms can be a valuable tool in identifying intersectional positions at a higher risk of not utilizing public resources and, thus, can aid substantially in developing targeted interventions to increase BCS attendance.

Coverage and associated factors with cervical cancer screening in Spain

Abstract Background Cervical cancer is a preventable cancer due to vaccination and screening. In Spain 80% of new cases of cervical cancer are women that haven't ever participated in screening programmes. It is outlined if this participation is properly done and if cervical cancer screening is still a challenge for public health in Spain. Our aims are to estimate cervical cancer screening coverage, distinguishing female participation ever and participation every three years according to current recommendations, and to identify the associated factors with participation in the screening. Methods An analysis from a subpopulation of the European Health Survey in Spain in 2020 was conducted. Women between 25 and 65 years old that answered the Adult and Home questionnaires were included. Our main variables were “not participating ever in cervical cancer screening”, and “incorrect participation”. A descriptive analysis of the variables and logistic regression models were developed to identify the determinants for the participation in cervical cancer screening. Results 6924 women fulfilled the selection criteria. The percentage of not participating ever in cervical cancer screening was 11.7%. The percentage of incorrect regularity of participation was 18.0%. Young and elderly women, low socio-economic educational level, sedentary lifestyle, absence of private health insurance, good self-perceived health and working as informal carer were associated with deficient women's participation in screening. Conclusions Despite high percentage of participation in cervical cancer screening, the frequency of women that participate correctly can be improved. Socio-economic factors, health perception and assurance, lifestyle, and informal care, have an influence in producing disparities in women's participation and regularity in cervical cancer screening. Future studies are needed to analyse the association among lifestyles, role of carer women and coverage of cervical cancer screening. Key messages • Impact of social determinants of health have been recognised in cervical cancer screening. • Specific programs for vulnerable women are needed to improve their participation in cervical cancer screening.

1699MO Intervening factors for participation and non-participation in colorectal cancer screening in Spain

1699MO Intervening factors for participation and non-participation in colorectal cancer screening in Spain

Knowledge, Compliance, and Inequities in Colon Cancer Screening in Spain: An Exploratory Study.

In Spain, inequities exist in implementing colorectal cancer (CRC) tests with the target population-adults aged 50 to 69-as part of population-based CRC screening programs. This research aims to further our understanding of the target population's awareness, attitudes, and perceptions of these test-based screening programs. A survey was carried out using an online panel representative of the target population, with a sample collected from 5313 individuals. Data collection took place in June 2022. Descriptive and bivariate analyses were carried out using contingency tables, the Chi-square test, and Cramer's V statistics. The sample was also segmented based on key variables. Finally, the results were analyzed using logistic regression. In the sample population, 62.5% had taken the fecal occult blood test (FOBT), 72.5% reported receiving the invitation letter to participate in the screening program, and 86.8% had prior knowledge of the FOBT. Noncompliance was mainly due to lack of symptoms (40%), non-receipt of invitation letters (39.7%), and forgetfulness or neglect (28.5%). On the contrary, receipt of the letter of invitation (OR 7.35, p < 0.01) and prior knowledge of FOBT (OR 6.32, p < 0.01) were the main variables that increased the probability of test uptake. Other significant variables included frequency of primary care visits (OR 1.71, p < 0.01) and being older (65-69 years old) (OR 1.52, p < 0.01) There is still a pressing need for greater awareness of both CRC risk factors and the benefits of early detection, as well as for overcoming the common misconception that detection should only be sought when symptoms are present.

Intervening factors for participation and non-participation in colorectal cancer screening in Spain.

e22552 Background: The Spanish Ministry of Health introduced a population-based colorectal screening program within its common services portfolio in 2014. The program targeted adults from 50 to 69 years. They receive a personal invitation letter asking them to perform the fecal occult blood test (FOBT). To achieve public health benefits on incidence, mortality and cost-effectiveness from this screening program a 65% participation in the program is needed1.Although participation rates have been improved since 2014, there is still room from improvement as only 56% of the Spanish regions reach the participacion threshold2. In this study we examined attitudinal and social factors impacting on participation in the target population. Methods: A CAWI survey was conducted among the target population of the screening program using a nation-wide citizen panel. A representative sample of the Spanish population, with size of 5131 valid responses, was obtained. The fieldwork was conducted in June 22nd. The data was analyzed using a descriptive analysis for the entire sample as well as the logistic regression technique using the maximum likelihood estimation. This technique allows us to determine the variables that have the greatest predictive capacity with respect to the participation (or non-participation) on the (FOBT). Results: We found that 97.6% of people have heard of colon cancer, 86.8% are aware of the test, 72.5% have received the program information letter and 62.5% have performed the test (FOBT). Furthermore, logistic regression demonstrates that the reception of a program information letter (OR=7,381, p&lt;0.01), and the prior knowledge of the screening test (FOBT) (OR=6,768, p&lt;0,01) significantly predicted the participation. Other variables with a high contribution were age between 62-69 (OR= 1,470, p&lt;0.01), the frequency of routine medical check-ups (OR= 1,717, p&lt;0.01), a positive perception of routine medical checkups (OR= 1,659, p&lt;0.01), and personal risk of colon cancer perception (OR= 1,404, p&lt;0.01). Conclusions: The effective participation in the program is influenced by factors that are unrelated to the implementation process (including the reception of the invitation letter). Most influential factors on actual participation on the program are the prior knowledge of the program and the importance attributed to routine heath checkups. Specific interventions on these variables should be done concurrently with expanding coverage in order to achieve the goals of higher effective participation.

Advances in shared decision-making for breast cancer screening in Spain

Advances in shared decision-making for breast cancer screening in Spain

Trends and Determinants in Uptake of Cervical Cancer Screening in Spain: An Analysis of National Surveys from 2017 and 2020.

Simple SummaryCervical cancer is the fourth leading cause of death and morbidity in women worldwide. Although screening is a successful technique for lowering these rates, there are still great differences in screening adherence in Spain. The aims of this study were to examine the evolution of cytology screening adherence from 2017 and 2020 and to identify the factors associated with uptake among women in Spain. We found that 73.18% of women had received a cytology test during the previous three years. From 2017 and 2020, there was an increase in cytology screening participation among women aged 45–65 years. Foreigners were less likely to have a cytology test. The characteristics associated with cervical cancer screening that we discovered have significant value for public health initiatives, as they will assist health professionals in identifying women who are less likely to undergo screening and encouraging these women to do so.Cervical cancer rates have declined in industrialized nations as a result of cytology screening programs. However, there are still sizeable differences in screening adherence in Spain. This study aimed to identify the prevalence of cervical cancer screening among women in Spain, to analyze trends in that prevalence from 2017 and 2020 and to identify socio-demographic, health, and lifestyle factors related with adherence to this screening test. We conducted a cross-sectional study of 13,619 women aged 25–65 who participated in the 2017 Spanish National Health Survey and the 2020 European Health Survey for Spain. We used logistic regression to examine the relationship between socio-demographic, health and lifestyle factors and cervical cancer adherence. The prevalence of adherence was 73.18%. Additionally, there was a significant decrease in cervical cancer screening uptake from 2017 and 2020 among women aged 25–44 years (2017: 77.80%, 2020: 75.20%, p = 0.02), but an increase in the age group of 45–65 years (2017: 68.93%, 2020: 72.39%, p < 0.01) and in foreigners (2017: 64.29%, 2020: 72.29%, p < 0.01). Screening for cervical cancer is related with age, educational level, social class, insurance status, visits to the family doctor, alcohol consumption and free time physical exercise.

Translated article] Lung Cancer Screening: Survival in an Extensive Early Detection Program in Spain (I-ELCAP)

IntroductionLung cancer (LC) is usually diagnosed at advanced stages with only a 12% 5-year survival. Trials as NLST and NELSON show a mortality decrease, which justifies implementation of lung cancer screening in risk population. Our objective was to show survival results of the largest LC screening program in Spain with low dosage computed tomography (LDCT). MethodsClinical records from International Early Lung Cancer Detection Program (IELCAP) at Valencia, Spain were analyzed. This program recruited volunteers, ever-smokers aged 40–80 years, since 2008. Results are compared to those from other similar sizeable programs. ResultsA total of 8278 participants were screened with at least two-rounds until November 2020. A mean of 6 annual screening rounds were performed. We detected 239 tumors along 12-year follow-up. Adenocarcinoma was the most common histology, being 61.3% at stage I. The lung cancer prevalence and incidence proportion was 1.5% and 1.4%, respectively with an annual detection rate of 0.17. One-year survival and 10-year survival were 90% and 80.1%, respectively. Adherence was 96.84%. ConclusionLargest lung cancer screening in Spain shows that survival is improved when is performed in multidisciplinary team experienced in management of LC, and is comparable to similar screening programs.

Factors Associated with Colorectal Cancer Screening in Spain: Results of the 2017 National Health Survey.

This study aimed to determine the CRC screening coverage of people aged between 50 and 69 years who were living in Spain in 2017 and describe the factors associated with not having had a faecal occult blood test (FOBT). A cross-sectional study was performed using data from the Spanish National Health Survey 2017. We analysed 7568 individuals between the ages of 50 and 69 years. The proportion of respondents between 50 and 69 years old who had had an FOBT was 29.0% (n = 2191). The three autonomous communities with the lowest proportion of respondents who had had an FOBT were Extremadura (8.7%, n = 16), Ceuta–Melilla (10.4%, n = 3), and Andalucia (14.1%, n = 186). The variables associated with not having had an FOBT were being 50–54 years old (PR = 1.09; 95% CI 1.04–1.14), having been born outside of Spain (PR = 1.11; 95% CI 1.06–1.16), not having been vaccinated against the flu (PR = 1.09; 95% CI 1.04–1.15), never having had a colonoscopy (PR = 1.49; 95% CI 1.40–1.59), not having had an ultrasound scan in the last year (PR = 1.09; 95% CI 1.04–1.14), and not having seen a primary care physician in the last month (PR = 1.08; 95% CI 1.04–1.12). The factors associated with not getting an FOBT were young age, having been born outside of Spain, not having been vaccinated against the flu in the last campaign, and not making frequent use of healthcare services.

Cribado de cáncer de pulmón: Supervivencia en un amplio programa de detección precoz en España (I-ELCAP)

IntroductionLung cancer (LC) is usually diagnosed at advanced stages with only a 12% 5-year survival. Trials as NLST and NELSON show a mortality decrease, which justifies implementation of lung cancer screening in risk population. Our objective was to show survival results of the largest LC screening program in Spain with low dosage computed tomography (LDCT). MethodsClinical records from International Early Lung Cancer Detection Program (IELCAP) at Valencia, Spain were analysed. This program recruited volunteers, ever-smokers aged 40-80 years, since 2008. Results are compared to those from other similar sizeable programs. ResultsA total of 8278 participants were screened with at least two-rounds until November 2020. A mean of 6 annual screening rounds were performed. We detected 239 tumours along 12-year follow-up. Adenocarcinoma was the most common histology, being 61.3% at stage I. The lung cancer prevalence and incidence proportion was 1.5% and 1.4%, respectively with an annual detection rate of 0.17. One-year survival and 10-year survival were 90% and 80.1%, respectively. Adherence was 96.84%. ConclusionLargest lung cancer screening in Spain shows that survival is improved when is performed in multidisciplinary team experienced in management of LC, and is comparable to similar screening programs.

Non-Participation in Breast Cancer Screening in Spain and Potential Application in the Present and Future: A Cross Sectional Study.

Simple SummaryBreast cancer screening programmes have the aim of reducing breast cancer mortality. This article is an observational, descriptive, cross-sectional and retrospective study of 2507 women who were invited to participate in the Breast Cancer Prevention Programme in Extremadura (Spain) and did not attend their appointment. We analysed the different reasons why women do not participate in the Breast Cancer Early Detection Programme in Extremadura (Spain) and discuss the results offering possible tools to improve the screening programs. Women who did not participate in the breast cancer screening programme in Extremadura had low educational levels and were older women.Background: Currently, we are beginning to observe a stabilisation and even a decrease in breast cancer mortality in the world, which may be related, among other reasons, to breast cancer screening. Methods: The objective of this study was to analyse the different reasons why women do not participate in the Breast Cancer Early Detection Programme in Extremadura (Spain) and to discuss the results, offering possible tools to improve the screening programs. This is an observational, descriptive, cross-sectional and retrospective study. A questionnaire with 14 questions was carried out by telephone or mail. Results: A total of 3970 questionnaires were collected. However, only 2507 were valid. A total of 70.36% of young and educated women underwent mammographic controls. The type of women who did not attend the screening programme appointment corresponded to a woman of approximately 60 years of age, with no formal studies, married, with children, who does not work outside their home and who lived in the health area of Badajoz. Among the main reasons for not going to the appointment, 53.9% of the women surveyed indicated that they had check-ups with their gynaecologist, and this specialist referred them for a mammograph. These women were younger and have a higher level of education. Women with a lower educational level and older women did not have any mammography done and did not undergo screening. They indicated that they did not go to the appointment because they were afraid of having a mammography (44%) or because they did not receive the appointment in time (31.6%). A total of 26.9% of the women who did not attend the appointment for other reasons stated that they had problems in attending because they had a physical limitation (dependency). Conclusions: Women who did not participate in the breast cancer screening programme in Extremadura had low educational levels and were older women. Specifically, fear of having a mammogram was the main argument raised by these women. In addition, a small group stated that they did not consider mammography to be useful. At present and in the future, good quality screening programs must be carried out to contribute to the reduction in breast cancer mortality. Furthermore, enhancing the participation of women is essential to increase the attendance rate and, therefore, the success of the screening programmes.

Effectiveness of a decision aid for promoting colorectal cancer screening in Spain: a randomized trial

BackgroundColorectal cancer (CRC) screening has shown to reduce incidence and mortality rates, and therefore is widely recommended for people above 50 years-old. However, despite the implementation of population-based screening programs in several countries, uptake rates are still low. Decision aids (DAs) may help patients to make informed decisions about CRC screening.MethodsWe performed a randomized controlled trial to assess the effectiveness of a DA developed to promote CRC screening, with patients from two primary care centers in Spain who never had underwent CRC screening. Contrary to center B (n = 24), Center A (n = 83) attended patients from an area where the population-based screening program was not implemented at that moment. Outcome measures were decisional conflict, knowledge of the disease and available screening options, intention to uptake the test, and concordance between patients’ goals/concerns and intention.ResultsIn center A, there were significant differences favoring the DA in decisional conflict (p < 0.001) and knowledge (p < 0.001). The absolute differences favoring DA group in intention to undergo fecal occult blood test (10.5%) and colonoscopy (13.7%) were significant only before correction for attenuation. In center B the differences were significant only for knowledge (p < 0.001). Patients’ goals and concerns regarding the screening did not significantly predict their intention, and therefore we could not calculate a measure of concordance between the two constructs.ConclusionsA DA improved the decisional process of participants who had never been invited to participate in the Spanish public CRC screening program, replicating previous results in this field. Future research is needed to identify subgroups that could benefit more from these interventions.Trial registrationInternational Standard Registered Clinical/social Study Number: ISRCTN98108615 (Retrospectively registered on 27 December 2018).

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

ObjectivesTo 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.DesignQualitative interview study with...

Prevalence and determinants in cytology testing for cervical cancer screening in Spain (2006-14).

Cervical cancer has decreased in developed countries thanks to cytology screening programmes. The aims of this study were To analyse the frequency and evolution of performing cytology tests and to determine the variables that influence their use. Cross-sectional study of non-institutionalized women who participated in the national health survey (2006, 2011/12) and the European Health Survey in Spain (2009, 2014). Study variables: cytology-testing, time since last cytology-test, reason for performing the test, age, nationality, marital status, social status, education level and place of residence. The study evaluated 53 628 women in Spain over 15 years old, with a mean age of 52.68 (SD ± 19.12). About 94.1% were Spanish, 49.2% were married and 77.2% lived with a partner. In 2014, 72% had a cytology test, a number that increased significantly. Women aged 25-65 were 5.13 times more likely to undergo a cytology test than those aged 15-24 years old (odds ratio (OR): 5.13; P < 0.001); women with university educations were 9.23 times more likely to undergo a cytology test than those without university educations (P > 0.001); those of social classes I and II (high) were 1.2 more likely to undergo a cytology test than those of low social class (P = 0.026); and Spanish women were 1.74 times more likely to undergo a cytology test than foreigners living in Spain (P < 0.001). Frequency of cytology testing has increased in the last few years. Screening for cervical cancer is associated with higher social status, education level, age, and not being foreign.

The effect of information about the benefits and harms of mammography on women\u2019s decision-making: study protocol for a randomized controlled trial

BackgroundThe decision to participate or not in breast cancer screening is complex due to the trade-off between the expected benefit of breast cancer mortality reduction and the major harm of overdiagnosis. It seems ethically necessary to inform women so that they can actively participate in decision-making and make an informed choice based on their values and preferences.The objective of this study is to assess the effects of receiving information about the benefits and harms of screening on decision-making, in women approaching the age of invitation to mammography screening.MethodsA two-stage, randomized controlled trial (RCT). In the first stage, 40 Basic Health Areas (BHAs) will be selected and randomized to intervention or control. In the second stage, women within each BHA will be randomly selected (n = 400). Four breast cancer screening programs (BCSPs) of the Spanish public health system, three in Catalonia and one in the Canary Islands will participate in the study. Women in the intervention arm will receive a leaflet with detailed information on the benefits and harms of screening using mammography. Women in the control arm will receive a standard leaflet that does not mention harms and recommends accepting the invitation to participate in the biennial examinations of the BCSP.The primary outcome is informed choice, a dichotomous variable that combines knowledge, attitudes, and intentions. Secondary outcomes include decisional conflict; confidence in the decision made; anxiety about screening participation; worry about breast cancer; anticipated regret; time perspective; perceived importance of benefits/harms of screening; perceived risk of breast cancer; and leaflet acceptability. Primary and secondary outcomes are assessed 2–3 weeks after the intervention.DiscussionThis is the first RCT that assesses the effect of informing about the benefits and harms of breast cancer screening in Spain in women facing the decision to be screened using mammography. It aims to assess the impact of information on several decisional outcomes and to contribute to paving the road towards shared decision-making in breast cancer screening in our country.Trial registrationClinicalTrials.gov registry, ID: NCT03046004. Retrospectively registered on 4 February 2017. Trial name: InforMa study.

Implementation of colorectal cancer screening in Spain: main results 2006-2011.

The Spanish Cancer Screening Network involves the participation of all regional programmes and has been working for over 20 years to co-ordinate strategies and implement quality assurance in current and new regional programmes. In colorectal cancer, the target population is the group aged 50-69 years, who are offered biennial testing using the faecal occult blood test in all programmes, with follow-up colonoscopy if the faecal occult blood test is positive. This article presents the main trends, indicators and differences by sex. The main indicators from 2006 to 2011 were analysed: coverage, participation rate, positivity rate, colonoscopy uptake and lesions detected. Annual trends were adjusted by sex and region. In 2011, coverage was 9.74% of the Spanish target population. A total of 1 001 669 first invitations were registered from 2006 to 2011 and 596 649 individuals participated in the programmes (43.83% participation rate). Results were positive in 30 544 individuals (5.47%), with the lowest positivity rate occurring in 2007 (3.06%) and the highest in 2011 (6.30%) (P<0.001). In all, 27 568 colonoscopies were registered, with a high compliance rate (90.00% in 2011 and 95.59% in 2007) (P=0.381). The adenoma and colorectal cancer detection rates increased over the period, reaching 32.25/1000 and 3.42/1000 participants in 2011, respectively (P<0.001 and P=0.001). Comparison of differences by sex showed that detection rates were significantly higher in men than in women (P<0.001). Participation increased over time and has now reached an acceptable rate. Men show low participation but higher detection rates, indicating the need for further intervention. The Spanish Cancer Screening Network provides common evaluation, performance and organizational benchmarking.

Acceptance, yield and feasibility of attaching HCV birth cohort screening to colorectal cancer screening in Spain

IntroductionThe US Centers for Disease Control recommends hepatitis C virus (HCV) screening for baby boomers. Spain presents a similar distribution of infected patients. We performed a cross sectional prospective study to evaluate the prevalence of undiagnosed HCV infection in subjects born between 1949 and 1974. MethodsAll out-patients within the age range, both symptomatic and screening procedures, undergoing colonoscopy between December 2014 and June 2015 were offered a HCV antibody blood test and a survey including risk factors for HCV infection and attitude toward HCV screening. Patients with chronic HCV or with a previous negative HCV antibody test were excluded. ResultsA total of 570 subjects, 50% screening procedures, were analyzed. The median age was 55.7, 94.6% were born in Spain and 54.6% were women. Antibodies against HCV were found in 1.6% (95% CI: 0.8–3%) and HCV-RNA in 0.4% (0.1–1.3%). We found no statistically significant differences regarding HCV prevalence, risk factors or socioeconomic characteristics between subjects undergoing colorectal cancer screening and symptomatic subjects. ConclusionSymptomatic and screening subjects undergoing colonoscopy support HCV screening and present a similar HCV risk profile. Results suggest linking colorectal and HCV screening would yield good results.

FRI-404 - Acceptance, Yield and Feasibility of Attaching HCV Birth Control Screening to Colorectal Cancer Screening in Spain

FRI-404 - Acceptance, Yield and Feasibility of Attaching HCV Birth Control Screening to Colorectal Cancer Screening in Spain

Tendencias y desigualdades sociales en el cribado de cáncer de cérvix y cáncer de mama en la Comunidad de Madrid durante el periodo 1995-2010 a partir del Sistema de Vigilancia de Factores de Riesgo de enfermedades no transmisibles (SIVFRENT-A)

BACKGROUND The assessment of preventive programs is necessary to support the decisions made in public health. There are few research studies that evaluate the degree of implementation and equity of cancer screening in Spain. The objective was to describe trends and inequalities in cervical and breast cancer screening according social determinants of health. METHODS An analysis was carried out on the Behavioral Risk Factor Surveillance System of Community of Madrid data, obtained between 1995 and 2000 from telephone surveys conducted on a population between ages 18 to 65, were analyzed. The years were grouped into four periods: P1 to P4. The trends were estimated with prevalence ratios (PR) with 95% confidence intervals (95% CI), obtained through generalized linear models with binomial family and logarithmic link. The inequalities were estimated with differences of proportions (DP) with 95% CI. RESULTS An increased in mammograms is seen especially in women with low education (PR P4/P1: 1.93; 95%CI 1.62 to 2.3), this trend more discreet in cytology (PR P4/P1: 1.28; 95%CI 1.11 to 1.47). However mammograms have not increased over in the past 5 years (PR P4/P3: 1.02; 95% CI 0.99 to 1.04). Inequalities get better, but show an increase in the last period. CONCLUSIONS All groups increase in preventative behaviors and those who did not, had a high prevalence from the start.Itis worth mentioning the stagnation of mammography in disadvantaged women in the period 2007-2010. There was a social gradient for preventive preventative measures, which was lower in the population-basedscreening (mammography) than in the opportunistic one (cytology).

Trends and social inequalities in cervical cancer and breast cancer screening in Madrid: Non-Commumicable Disease Risk FactorSurveillance System (SIVFRENT-A) from 1995 to 2010

The assessment of preventive programs is necessary to support the decisions made in public health. There are few research studies that evaluate the degree of implementation and equity of cancer screening in Spain. The objective was to describe trends and inequalities in cervical and breast cancer screening according social determinants of health. An analysis was carried out on the Behavioral Risk Factor Surveillance System of Community of Madrid data, obtained between 1995 and 2000 from telephone surveys conducted on a population between ages 18 to 65, were analyzed. The years were grouped into four periods: P1 to P4. The trends were estimated with prevalence ratios (PR) with 95% confidence intervals (95% CI), obtained through generalized linear models with binomial family and logarithmic link. The inequalities were estimated with differences of proportions (DP) with 95% CI. An increased in mammograms is seen especially in women with low education (PR P4/P1: 1.93; 95%CI 1.62 to 2.3), this trend more discreet in cytology (PR P4/P1: 1.28; 95%CI 1.11 to 1.47). However mammograms have not increased over in the past 5 years (PR P4/P3: 1.02; 95% CI 0.99 to 1.04). Inequalities get better, but show an increase in the last period. All groups increase in preventative behaviors and those who did not, had a high prevalence from the start.Itis worth mentioning the stagnation of mammography in disadvantaged women in the period 2007-2010. There was a social gradient for preventive preventative measures, which was lower in the population-basedscreening (mammography) than in the opportunistic one (cytology).