Inequalities In Cancer Screening Participation Research Articles

Inequalities in cancer screening participation between adults with and without severe mental illness: results from a cross-sectional analysis of primary care data on English Screening Programmes

BackgroundPeople with severe mental illness (SMI) are 2.5 times more likely to die prematurely from cancer in England. Lower participation in screening may be a contributing factor.MethodsClinical Practice Research Datalink data for 1.71 million, 1.34 million and 2.50 million adults were assessed (using multivariate logistic regression) for possible associations between SMI and participation in bowel, breast and cervical screening, respectively.ResultsScreening participation was lower among adults with SMI, than without, for bowel (42.11% vs. 58.89%), breast (48.33% vs. 60.44%) and cervical screening (64.15% vs. 69.72%; all p < 0.001). Participation was lowest in those with schizophrenia (bowel, breast, cervical: 33.50%, 42.02%, 54.88%), then other psychoses (41.97%, 45.57%, 61.98%), then bipolar disorder (49.94%, 54.35%, 69.69%; all p-values < 0.001, except cervical screening in bipolar disorder; p-value > 0.05). Participation was lowest among people with SMI who live in the most deprived quintile of areas (bowel, breast, cervical: 36.17%, 40.23%, 61.47%), or are of a Black ethnicity (34.68%, 38.68%, 64.80%). Higher levels of deprivation and diversity, associated with SMI, did not explain the lower participation in screening.ConclusionsIn England, participation in cancer screening is low among people with SMI. Support should be targeted to ethnically diverse and socioeconomically deprived areas, where SMI prevalence is greatest.

Trends in socioeconomic inequalities in cervical, breast, and colorectal cancer screening participation among women in Japan, 2010–2019

BackgroundIt is known that socioeconomic status (SES) influences the outcome of cancer treatment and this could partly be explained by decreased use of cancer screening services by people of lower SES. Many studies have indicated that low SES, including low educational attainment or unstable employment, was related to nonparticipation in cancer screening. However, studies investigating trends in SES inequalities within cancer screening participation are limited. Our objective was to examine trends in SES inequalities in cervical, breast, and colorectal cancer screening participation among women in Japan between 2010 and 2019. MethodsWe analyzed 189,442, 168,571, 163,341, and 150,828 women in 2010, 2013, 2016, and 2019 respectively, using nationally representative cross-sectional surveys. The main outcome variables are participation in each cancer screening. We used educational attainment and employment status as measures for SES. Multivariable logistic regression analysis, adjusted for age, marital status, educational attainment, and employment status was performed to evaluate the associations between SES and nonparticipation in each cancer screening. ResultsOverall participation rates in each cancer screening increased between 2010 and 2019. Low educational attainment and non-permanent employment status were related to nonparticipation in each cancer screening and inequality according to employment status increased within each screening participation during the study period. For example, dispatched workers were more likely to not participate in cervical cancer screening than permanent workers: in 2010, [aOR 1.11 95 %CI: 1.01 –1.21], and in 2019, [aOR 1.46 95 %CI: 1.34–1.60]. The inequality was greatest in colorectal cancer screening nonparticipation, followed by breast and cervical screening. ConclusionsAlthough the participation rates in each cancer screening have increased, inequality in participation in terms of employment status widened among women in Japan between 2010 and 2019. Reducing inequalities in cancer screening participation is essential for cancer screening intervention policies.

Social inequalities in participation in cancer screening: does the mode of data collection matter? The CONSTANCES cohort.

Self-reported data are prone to item non-response and misreporting. We investigated to what extent the use of self-reported data for participation in breast (BCS) and cervical cancer screening (CCS) impacted socioeconomic inequalities in cancer screening participation. We used data from a large population-based survey including information on cancer screening from self-reported questionnaire and administrative records (n = 14122 for BCS, n = 27120 CCS). For educational level, occupation class and household income per capita, we assessed the accuracy of self-reporting using sensitivity, specificity and both positive and negative predictive value. In addition, we estimated to what extent the use of self-reported data modified the magnitude of socioeconomic differences in BCS and CCS participation with age-adjusted non-screening rate difference, odds ratios and relative indices of inequality. Although women with a high socioeconomic position were more prone to report a date for BCS and CCS in questionnaires, they were also more prone to over-declare their participation in CCS if they had not undergone a screening test within the recommended time frame. The use of self-reported cancer screening data, when compared with administrative records, did not impact the magnitude of social differences in BCS participation but led to an overestimation of the social differences in CCS participation. This was due to misreporting rather than to item non-response. Women's socioeconomic position is associated with missingness and the accuracy of self-reported BCS and CCS participation. Social inequalities in cancer screening participation based on self-reports are likely to be overestimated for CCS.

Assessing the implementation of interventions addressing socioeconomic inequalities in cancer screening in high-income countries.

Background: The context of an intervention may influence its effectiveness and success in meeting the needs of the targeted population. Implementation science frameworks have been developed, but previous literature in this field has been mixed. This paper aimed to assess the implementation success of interventions, identified from a systematic review, that reduced inequalities in cancer screening between people in low and high socioeconomic groups.Design and Methods: The implementation framework by Proctor et al. was utilised to assess the potential success of 6 studies reporting on 7 interventions in the “real-world” environment. A standardised rating system to identify the overall implementation success of each intervention was established.Results: Four interventions (57%) demonstrated high potential to be implemented successfully. Interventions included enhanced reminder letters and GP-endorsed screening invitations, containing evidence on the acceptability, from participants and stakeholders, appropriateness and direct cost of the intervention.Conclusion: While some interventions reduced socioeconomic inequalities in cancer screening participation, there have been missed opportunities to integrate the experiences of the targeted population into design and evaluation components. This has limited the potential for transferability of outcomes to other settings.Significance for public healthInterventions may be effective within a research context and the sample population but may not equally benefit all when implemented. Implementation science frameworks are useful in understanding how and why an intervention may succeed or fail in the “real-world” environment. This project assessed the implementation success of interventions, identified from a systematic review that reduced inequalities in cancer screening between people in low and high socioeconomic groups. Over half of the interventions that produced a positive impact in the research context had high potential for implementation success. This assessment demonstrated that no one size fits and for the socioeconomically disadvantaged, input from these participants along the implementation spectrum is a crucial element for ensuring transferability to other settings. To make sure finite research funding is used effectively, engagement with disadvantaged populations is of public health importance because programs or services need to be tailored to their specific needs to reduce inequalities.

The impact of regional screening policies on the diffusion of cancer screening participation in Belgium: time trends in educational inequalities in Flanders and Wallonia

BackgroundWe investigate whether the extent of educational inequalities in the use of Pap smears (cervical cancer screening) and mammograms (breast cancer screening) in Belgium has changed over time in accordance with the pattern predicted by diffusion of innovation theory, as well as how the regional cancer screening policies of Flanders and Wallonia influence this pattern.MethodsData were obtained from five successive cross-sectional waves (1997–2001–2004-2008-2013) of the Belgian Health Interview Survey. Final sample sizes consisted of 8988 women aged 25–64 years for cervical cancer screening and 4194 women aged 50–69 years for breast cancer screening. We calculated absolute and relative measures of inequality, more specifically, the slope index of inequality (SII) and the relative index of inequality (RII), and their development over time.ResultsIn both Flanders and Wallonia, mammogram use increased greatly between 1997 and 2013, while Pap smear use has remained quite stable over time. Educational inequalities in cervical-cancer screening have been largely persistent over time in both regions. In contrast, educational inequalities in breast cancer screening fluctuated more between 1997 and 2013. Between 1997 and 2001, when the breast cancer screening programme was implemented in Flanders, RII reduced significantly by 45%. Inequality measures did not change significantly in Wallonia, where it is known that most women are screened opportunistically outside the programme.ConclusionsBy focussing on Belgium, this study demonstrates that regional variations in the support of a national screening programme can result in regional variations in the pattern of diffusion for cancer screening, as well as to the development of inequalities in cancer screening participation. Moreover, the findings demonstrate that high visibility and awareness of the screening programme, as was more the case in Flanders than it was in Wallonia, are required in order to reduce or eliminate educational inequalities in cancer screening participation over time. General practitioners and gynaecologists can play a decisive role in this regard.

Abstract C72: Changing patterns of socioeconomic inequalities in women cancer screening in South Korea with ten years follow-up of nationwide cross-sectional study

Abstract C72: Changing patterns of socioeconomic inequalities in women cancer screening in South Korea with ten years follow-up of nationwide cross-sectional study

The education gradient in cancer screening participation: a consistent phenomenon across Europe?

To extend the literature on educational inequalities in cancer screening participation (1) by simultaneously focusing on participation in screening for cervical, breast and colorectal cancer across 27 European countries and (2) by statistically testing whether these educational inequalities vary according to country-specific screening strategies: organised or opportunistic. Self-reported data from Eurobarometer 66.2 (2006) on cancer screening participation in the preceding 12months were used to outline cross-national variations in screening strategies, target populations and participation rates. Multilevel logistic regressions were applied. Individuals with higher levels of education were more likely to participate in screening for cervical, breast and colorectal cancer than were those with less education. Educational inequalities in cancer screening participation were significantly smaller in countries with organised screening for cervical (OR = 0.696, 95% CI 0.531–0.912), breast (OR = 0.628, 95% CI 0.438–0.900) and colorectal (OR = 0.531, 95% CI 0.303–0.932) cancer than they were in countries with opportunistic screening. The same interaction was observed for participation in screening for breast and colorectal cancer, albeit with marginal significance. This study clearly highlights the crucial role of educational level in the likelihood of participating in cancer screening. Countries can reduce educational inequalities by applying organised screening programmes.

Inequalities in cancer screening participation: examining differences in perceived benefits and barriers.

ObjectiveInequalities exist in colorectal cancer (CRC) screening uptake, with people from lower socioeconomic status backgrounds less likely to participate. Identifying the facilitators and barriers to screening uptake is important to addressing screening disparities. We pooled data from 2 trials to examine educational differences in psychological constructs related to guaiac fecal occult blood testing.MethodsPatients (n = 8576) registered at 7 general practices in England, within 15 years of the eligible age range for screening (45‐59.5 years), were invited to complete a questionnaire. Measures included perceived barriers (emotional and practical) and benefits of screening, screening intentions, and participant characteristics including education.ResultsAfter data pooling, 2181 responses were included. People with high school education or no formal education reported higher emotional and practical barriers and were less likely to definitely intend to participate in screening, compared with university graduates in analyses controlling for study arm and participant characteristics. The belief that one would worry more about CRC after screening and concerns about tempting fate were strongly negatively associated with education. In a model including education and participant characteristics, respondents with low emotional barriers, low practical barriers, and high perceived benefits were more likely to definitely intend to take part in screening.ConclusionsIn this analysis of adults approaching the CRC screening age, there was a consistent effect of education on perceived barriers toward guaiac fecal occult blood testing, which could affect screening decision making. Interventions should target specific barriers to reduce educational disparities in screening uptake and avoid exacerbating inequalities in CRC mortality.

Socioeconomic inequalities in breast and cervical screening coverage in England: are we closing the gap?

ObjectiveHealth policy in the UK is committed to tackling inequalities in cancer screening participation. We examined whether socioeconomic inequalities in breast and cervical cancer screening participation in England have reduced over five years.MethodsCross-sectional analyses compared cervical and breast screening coverage between 2007/8 and 2012/13 in Primary Care Trusts (PCTs) in England in relation to area-level income deprivation.ResultsAt the start and the end of this five year period, there were socioeconomic inequalities in screening coverage for breast and cervical screening. Inequalities were highest for breast screening. Over time, the coverage gap between the highest and lowest quintiles of income deprivation significantly reduced for breast screening (from 12.3 to 8.3 percentage points), but not for cervical screening (5.3 to 4.9 percentage points).ConclusionsEfforts to reduce screening inequalities appear to have resulted in a significant improvement in equitable delivery of breast screening, although not of cervical screening. More work is needed to understand the differences, and see whether broader lessons can be learned from the reduction of inequalities in breast screening participation.

Psychosocial Determinants of Socioeconomic Inequalities in Cancer Screening Participation: A Conceptual Framework

Cancer screening participation shows a strong, graded association with socioeconomic status (SES) not only in countries such as the United States, where insurance status can be a barrier for lower income groups, but also in the United Kingdom, where the National Health Service provides all health care to residents, including screening, for free. Traditionally, the literature on socioeconomic inequalities has focused on upstream factors, but more proximal (downstream) influences on screening participation also need to be examined, particularly those that address the graded nature of the association rather than focusing specifically on underserved groups. This review offers a framework that links some of the components and corollaries of SES (life stress, educational opportunities, illness experience) to known psychosocial determinants of screening uptake (beliefs about the value of early detection, fatalistic beliefs about cancer, self-efficacy). The aim is to explain why individuals from lower SES backgrounds perceive cancer screening tests as more threatening, more difficult to accomplish, and less beneficial. A better understanding of the mechanisms through which lower SES causes negative attitudes toward screening could facilitate the development of intervention strategies to reduce screening inequalities.