Inequalities In Breast Cancer Screening Research Articles

Socioeconomic status index is an independent determinant of breast cancer screening practices: Evidence from Eastern China.

Breast cancer is the most prevalent malignancy affecting Chinese women, and early routine screening is incredibly important for its prevention and control. This study aimed to investigate the role of socioeconomic status (SES) in female breast cancer screening practices using the composite SES index. This cross-sectional study involved 1816 women in Eastern China. Data were collected using an online self-administered questionnaire from January 2020 to May 2021. We used principal component analysis to construct the composite SES index using educational level, annual household income, and occupation. Logistic regression was used to analyze the association between the SES index and breast cancer screening utilization. Of the participants, 19.27% reported having performed breast self-examination, 12.89% reported having undergone clinical breast examination, and 3.52% reported having received mammography. The SES has a significant influence on the patronage of female breast cancer screening in Eastern China. The composite SES index was found to have a positive and significant association with breast cancer screening practices. An interaction was found between the SES index and patient characteristics, such as health awareness, marital status, and location of residence. In addition, the SES index had a positive effect on breast cancer-related knowledge. Socioeconomic inequalities existed in Eastern China and were related to breast cancer screening patronage. The composite SES index was identified as a significant determinant of breast cancer screening practices. Our results highlighted the negative impacts of socioeconomic inequities on female breast cancer screening utilization. This suggests that reducing socioeconomic inequalities in breast cancer screening requires more focused interventions and concerted outreach activities for groups with lower education levels, lower income, or lower occupational classes.

143 (PB-056) Poster - Coverage and Socio-economic inequalities in breast cancer screening in Low- and Middle-Income Countries: Analysis of Demographic and Health Surveys between 2010 and 2019

Background: Breast cancer is the most diagnosed cancer among women living in low- and middle-income (LMICs). The majority of the women are diagnosed with advanced-stage disease. The World Health Organisation (WHO) launched the Global Breast Cancer Initiative (GBCI) in 2020 intending to reduce global breast cancer mortality by 2.5% per year until 2040, thereby averting an estimated 2.5 million deaths. Pillar 1 of the initiative aims to achieve a diagnosis of at least 60% of invasive breast cancers at stage I or II which can be attained by robust screening.

Coverage and Socio-Economic Inequalities in Breast Cancer Screening in Low- and Middle-Income Countries: Analysis of Demographic and Health Surveys Between 2010 and 2019

PURPOSE The World Health Organisation (WHO) launched the Global Breast Cancer Initiative (GBCI) in 2020 intending to reduce global breast cancer mortality by 2.5% per year until 2040, thereby averting an estimated 2.5 million deaths. In this study, we aimed to determine the coverage and socio-economic inequalities in the screening for breast cancer over one decade before the establishment of the GBCI. METHODS For each country, using STATA 16 software and sampling weights, we analyzed the datasets of Demographic and Health Surveys (DHS) that included questions on breast cancer screening and were conducted between 2010 and 2019 in low- and middle-income countries. We included women aged 15-49 years and considered screening using breast self-examination (BSE), clinical breast examination (CBE), and mammography. Absolute and relative inequalities were determined using the Slope Index of Inequality (SII) and Concentration Index (CIX) respectively. RESULTS A total of 18 surveys from 13 countries were included in this study. Only six surveys from five countries measured the rates of screening by mammography which ranged from 5.58% to 12.96%. Considering screening using any method, the proportion that had ever screened for breast cancer ranged from 2.53% to 60.21%. Higher rates of screening were seen in upper-middle-income countries compared to low-income countries. For the CIX for screening using any method, the inequalities were pro-rich in all the countries except the Philippines where it was pro-poor with a CIX of –2.84 ( P value .015). For the CIX and SII for screening using mammography, the inequalities were pro-rich in all the countries. CONCLUSION There exist socio-economic disparities in the coverage of breast cancer using mammography, clinical breast examination, and breast self-exam. There is a need to address these disparities to achieve the targets of breast cancer control by the GBCI.

Intersectional social-economic inequalities in breast cancer screening in India: analysis of the National Family Health Survey

BackgroundBreast cancer incidence rates are increasing in developing countries including India. With 1.3 million new cases of cancer been diagnosed annually, breast cancer is the most common women’s cancer in India. India’s National Family Health Survey (NFHS-4) data 2015–2016 shows that only 9.8% of women between the ages of 15 and 49 had ever undergone breast examination (BE). Further, access to screening and treatment is unequally distributed, with inequalities by socio-economic status. It is unclear, however, if socio-economic inequalities in breast examination are similar across population subgroups.MethodsWe compared BE coverage in population sub-groups categorised by place of residence, religion, caste/tribal groups, education levels, age, marital status, and employment status in their intersection with economic status in India. We analysed data for 699,686 women aged 15–49 using the NFHS-4 data set conducted during 2015–2016. Descriptive (mean, standard errors, and confidence intervals) of women undergoing BE disaggregated by dimensions of inequality (education, caste/tribal groups, religion, place of residence) and their intersections with wealth were computed with national weights using STATA 12. Chi-square tests were performed to assess the association between socio-demographic factors and breast screening. Additionally, the World Health Organisation’s Health Equity Assessment Toolkit Plus was used to compute summary measures of inequality: Slope index for inequality (SII) and Relative Concentration Indices (RCI) for each intersecting dimension.ResultsBE coverage was concentrated among wealthier groups regardless of other intersecting population subgroups. Wealth-related inequalities in BE coverage were most pronounced among Christians (SII; 20.6, 95% CI: 18.5–22.7), married (SII; 14.1, 95% CI: 13.8–14.4), employed (SII: 14.6, 95%CI: 13.9, 15.3), and rural women (SII; 10.8, 95% CI: 10.5–11.1). Overall, relative summary measures (RCI) were consistent with our absolute summary measures (SII).ConclusionsBreast examination coverage in India is concentrated among wealthier populations across population groups defined by place of residence, religion, age, employment, and marital status. Apart from this national analysis, subnational analyses may also help identify strategies for programme rollout and ensure equity in women’s cancer screening.

Social inequalities in breast cancer screening: evaluating written communications with immigrant Haitian women in Montreal

BackgroundThe province of Quebec (Canada) has implemented a breast cancer screening program to diagnose this cancer at an early stage. The strategy is to refer women 50 to 69 years old for a mammogram every two years by sending an invitation letter that acts as a prescription. Ninety per cent (90%) of deaths due to breast cancer occur in women aged 50 and over. Numerous studies have shown social inequalities in health for most diseases. With breast cancer, a significant paradox arises: its incidence is lower among disadvantaged women and yet, more of them die from this disease. The health care system might play a role in this inequality. The scientific literature documents the potential for creating such inequalities when prevention does not consider equity among social groups. Immigrant women are often disadvantaged. They die of breast cancer more than non-immigrants. Studies attribute this to late-stage diagnosis due to poor adherence to mammography screening programs.Purpose of the studyThe main objective of our research is to assess how Haitian immigrant women in Montreal are reached by the Quebec Breast Cancer Screening Program, and specifically how they perceive the mammogram referral letter sent by the program.MethodsThe study uses a two-step qualitative method: i) In-depth interviews with influential community workers to identify the most relevant issues; ii) Focus groups with disadvantaged women from Montreal’s Haitian community.ResultsA mammogram referral letter from the Breast Cancer Screening Program may be a barrier to compliance with mammography by underprivileged Haitian women in Montreal. This might be attributable to a low level of literacy, poor knowledge of the disease, and lack of financial resources.ConclusionBarriers may be underestimated in underprivileged immigrant and non-immigrant communities. A preventive strategy must be adapted to different sub-groups and must also take into account lower literacy levels. To increase mammography uptake, it is crucial that the benefits of prevention be clearly identified and described in understandable terms. Finally, economic access to follow-up measures should be considered.

Socioeconomic Inequalities in Uptake of Breast Cancer Screening among Saudi Women: A Cross-Sectional Analysis of a National Survey.

Timely and adequate screening for breast cancer could improve health outcomes and reduce health costs. However, the utilization of free breast cancer screening services among Saudi women is very low. This study aims to investigate socioeconomic inequalities in breast cancer screening among Saudi women. The data of this study were extracted from the nationally representative Saudi Health Interview Survey, conducted in 2013; the study included 2786 Saudi women. Multivariate logistic regression, the concentration curve, and the concentration index were used to examine, illustrate, and quantify income- and education-related inequalities in three outcomes: Knowledge about self-breast examination (SBE), clinical breast examination (CBE) received in the last year, and mammography, that has ever been previously carried out. Results showed a marked socioeconomic gradient in breast cancer screening services. The concentration index by income was 0.229 (SBE), 0.171 (CBE), and 0.163 (mammography). The concentration index by education was 0.292 (SBE), 0.149 (CBE), and 0.138 (mammography). Therefore, knowledge about breast cancer screening, and the utilization of screening services, were more concentrated among richer and better-educated women. Poorer and less educated women had less knowledge about self-breast examination, and had considerably less adherence to clinical breast examination and mammography. The findings are helpful for policy makers to devise and implement strategies to promote equity in breast cancer screening among Saudi 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.

Decomposing income inequalities in breast and cervical cancer screening non-adherence in France: The CONSTANCES cohort survey

Background Socioeconomic inequalities are observed in breast cancer screening (BCS) and cervical cancer screening (CCS) in France. A large range of determinants is associated with BCS and CCS. Most of these determinants are socially stratified and are likely to contribute to socioeconomic inequalities in BCS and CCS. Various factors associated with BCS and CCS non-adherence have been identified in many studies. However, limited evidence exists on their contributions to socioeconomic inequalities. This study quantified the contributions of these determinants to BCS and CCS income inequalities in France. Methods The study utilised the 2012–2014 baseline data in the CONSTANCES survey conducted in France (10,260 women for BCS and 18,761 for CCS). Screening non-adherence was defined by having last BCS for more than 2 years and last CCS for more than 3 years. The standard concentration index (Ch) was computed to measure the income inequalities in BCS and CCS non-adherence. Decomposition analyses quantified the contributions of the determinants to the income inequalities. We used the method proposed by Wagstaff. A large range of determinants were accounted for: sociodemographic (age, partner, children, migration status, area of residence), socioeconomic (education, employment status, unmet healthcare need for financial reasons), healthcare access (health insurance for low-income individuals, potential spatial accessibility to gynecologists and general practitioners), health status (measured BMI, taking anti-diabetic treatment, taking antihypertensive treatment, self-reported physical limitations, self-reported cognitive limitation, personal history of cancer, family history of cancer, perceived health status, self-reported smoking status) and healthcare use (last visit to a gynaecologist from inclusion, number of GP visits during the inclusion year; and last glucose test from inclusion). Results BCS non-adherence was concentrated towards the lower income groups [Ch = −0.0756 (95% CI: −0.1000 to −0.0512)], these inequalities were explained mainly by less frequent visit to gynaecologist (50.0%), more unmet healthcare needs (13.9%) and higher BMI status (8.4%) in lower income groups. CCS non-adherence was concentrated towards the poorer groups [Ch = −0.1264 (CI: −0.1422 to −0.1106)], these inequalities were mostly explained by less frequent visit to gynaecologist (54.6%), having a partner (8.2%), and more unmet healthcare needs (7.0%) in lower income groups. Regular visits to general practitioner contributed negatively to both inequalities in BCS and CCS non-adherence (−10.2% and −4.8%, respectively): they were associated with lower BCS and CCS non-adherence and they were more common in poorer women. Conclusion Awareness of healthcare professionals should be raised regarding different factors contributing to the socioeconomic inequalities in BCS and CCS non-adherence as they are in the front-line of giving health advice adapted to women's characteristics.

Socioeconomic Inequalities in Cervical and Breast Cancer Screening among Women in Korea, 2005-2015.

PurposeConsistent evidence indicates that cervical and breast cancer screening rates are low among socioeconomically deprived women. This study aimed to assess trends in cervical and breast cancer screening rates and to analyze socioeconomic inequalities among Korean women from 2005 to 2015.Materials and MethodsData from the Korean National Cancer Screening Survey, an annual nationwide cross-sectional survey, were utilized. A total of 19910 women were finally included for analysis. Inequalities in education and household income status were estimated by slope index of inequality (SII) and relative index of inequality (RII), along with calculation of annual percent changes (APCs), to show trends in cancer screening rates.ResultsCervical and breast cancer screening rates increased from 54.8% in 2005 to 65.6% in 2015 and from 37.6% in 2005 to 61.2% in 2015, respectively. APCs in breast cancer screening rates were significant among women with higher levels of household income and education status. Inequalities by household income in cervical cancer screening uptake were observed with a pooled SII estimate of 10.6% (95% CI: 8.1 to 13.2) and RII of 1.4 (95% CI: 1.3 to 1.6). Income inequalities in breast cancer screening were shown to gradually increase over time with a pooled SII of 5.9% (95% CI: 2.9 to 9.0) and RII of 1.2 (95% CI: 0.9 to 1.3). Educational inequalities appeared to diminish over the study period for both cervical and breast cancer screening.ConclusionOur study identified significant inequalities among socioeconomically deprived women in cervical and breast cancer screening in Korea. Especially, income-related inequalities were greater than education-related inequalities, and these were constant from 2005 to 2015 for both cervical and breast cancer screening.

Assessing inequalities in preventive care use in Europe

This paper presents new international evidence on the extent of inequalities in breast cancer screening and blood test (cholesterol and blood sugar test) in 13 European Countries using data from the 2009 wave of the Survey of Health, Ageing and Retirement in Europe (SHARE). One important contribution of the paper is the inclusion of preexisting health conditions in the needs standardization procedure with the aim of taking into account utilization due to diagnosis or follow-up reasons. We find evidence of pro-rich inequalities in blood test use in some countries while high inequalities emerge in virtually every country with respect to mammography use. Decomposition analysis reveals that inequalities in mammography use are mostly driven by income while preventive needs distribution is only slightly pro-rich. On the other side, richer individuals appear to be much more likely to do blood tests despite their substantially lower diagnostic needs for that care. Generally, inequalities in mammography use are higher in countries without national breast cancer screening programs or in countries with only regional or less participated programs. Inequalities in blood tests are higher in countries with a high share of out-of-pocket payments and/or non universalistic entitlement to insurance coverage.

Health inequalities in breast cancer screening

Health inequalities in breast cancer screening