Non-screened Women Research Articles

Customer-Care Initiatives of Service Providers and the Uptake of Breast and Cervical Cancer Screening Services in Mutare, Zimbabwe

Social marketing globally promotes social mobilization to increase uptake of recommended health services. The Ministry of Health and Child Care in Zimbabwe markets breast and cervical cancer screening for reproductive-age women. Despite efforts, uptake remains low, particularly in Mutare district. To address this, an analytical cross-sectional study was conducted in Dangamvura suburb to explore the relationship between service providers' customer-care initiatives and screening uptake. Qualitative and quantitative data was collected via interviews with 96 women aged 18 to 49, randomly selected from Dangamvura Poly-Clinic departments. Of these women, 13.5% were screened for breast cancer, 30.3% for cervical cancer, and 78.8% expressed intent to screen. 90.3% had accurate knowledge of breast and cervical cancer, but only 30.3% could identify screening sites. Among those screened, 75.8% intended to retest. Primary motivations for screening included a desire for health status knowledge (39.2%) and reproductive system issues (32.1%). Main barriers for non-screened women were lack of motivation (56%) and fear of positive results (16.7%). Logistic regression indicated protective factors for screening uptake: history of reproductive issues (AOR: 9.0678, p: 0.0029), prior breast cancer screening (AOR: 21.4347, p: 0.0006), and age 31 to 49 (AOR: 0.1754, p: 0.0066). Overall, uptake was low, influenced by customer factors (age, reproductive issues, prior breast cancer screening) and cost factors (perceived wait times, screening duration, perceived costs). Future interventions aimed at improving uptake of screening services should be tailored to address fears, misconceptions, and lack of motivation to screen among women of reproductive age.

Evaluation of the Possible Benefits of Breast Cancer Screening in Women Aged 40 to 49 Years in the Steel Valley Region, Brazil

Background: This study investigates the effectiveness of mammographic screening for women aged 40 to 49 in Brazil's Steel Valley Region. Despite a Ministry of Health recommendation to start screenings at 50, 25% of breast cancer cases occur in the 40-49 age group. Methods: The retrospective analysis, spanning 2008-2019 at Marcio Cunha Hospital, compared two groups: cancer diagnosed via screening mammography (277) and diagnostic mammography (229). Results: Results showed delayed diagnoses for non-screened women, with 4.16 times higher mortality rate. Screening facilitated earlier detection of less malignant cancers (85.9% vs. 43.7%). Women diagnosed through screening were more likely to preserve their breasts (28.9% vs. 55.5% for Radical Breast Surgery and 71.1% vs. 28.9% for Breast-Sparing Surgery), and fewer axillary lymphadenectomies were performed. All statistical tests performed returned a p-value lower than 0.05 showing high statistical significance. Conclusion: The findings support extending screening mammography access to all women over 40 in the Steel Valley region and underscore the need for broader-scale research in other areas. Recommendations include enhancing public awareness and establishing a breast cancer surveillance service.

Long-term follow-up of cervical cancer incidence after normal cytological findings.

An increase in cervical cancer incidence in Sweden from 2014 to 2015 has been attributed to an increase in false-negative cytological findings before cancer diagnoses. Years later, we performed a long-term follow-up to investigate whether the problem persisted. At each calendar year from 2016 to 2020, we identified women with prior normal cervical screening results through linkage to the Swedish National Cervical Screening Registry. We reported their incidence rates (IRs) of invasive cervical cancer in consecutive years and compared the IRs over time. For the years 2016 to 2020, there was no overall change in cervical cancer incidence after two normal cytology in the last two screening intervals. However, there was a further 62% increase among women 50 to 60 years of age with normal cytology in the past two screening intervals. The incidence rate of cervical cancer was high among nonscreened women and low among HPV-screened women with negative results, with no trends over time. Our results imply that the previously reported decrease in sensitivity of cervical cytology is persisting. Although primary cytology screening is no longer used, cytology is used in triaging among HPV-positive women. Our findings suggest that improved triaging is needed, for example, improved quality assurance and/or use of alternative triage tests.

Socioeconomic, lifestyle and biological determinants of cervical screening coverage: Lolland-Falster Health Study, Denmark.

Cervical cancer is preventable. Screening is important for early detection. However, even in high-income countries, coverage is sub-optimal. We identified socioeconomic, lifestyle and biological determinants of cervical screening coverage. In Denmark, women aged 23-64 are free of charge personally invited to screening. All cervical cell samples are registered centrally in the Patobank. We linked data from the Lolland-Falster Health Study (LOFUS) with Patobank data. LOFUS was a population-based health survey undertaken in 2016-2020. With logistic regression, coverage defined as ≥1 cervical sample registered within a 6-year period from 2015 to 2020 was compared across levels of risk factors expressed as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Among 13 406 women of screening aged 23-64 and invited to LOFUS, 72% had ≥1 cervical sample registered. Non-participation in LOFUS was a strong predictor of low coverage; aOR 0.32; 95% CI 0.31-0.36. Among LOFUS participants, education was a strong predictor of coverage in univariate analysis, OR 0.58; 95% CI 0.48-0.71, but this association disappeared in multi-variate analysis, aOR 0.86; 95% CI 0.66-1.10. In multi-variate analysis, predictors of low coverage were high age, living without a partner, retired, current smoker, poor self-rated health, elevated blood pressure and elevated glycated haemoglobin. Women with low cervical screening coverage had limited contact to healthcare, exemplified by non-participation in LOFUS, and pertinent health and social problems, exemplified by elevated blood pressure and glycated haemoglobin, poor self-rated health, and retirement already in screening age. Structural changes in screening are needed to reach non-screened women.

HSD10 Efficiency of the Cervical Cancer Program on the Budget Execution Processes during COVID 19 Pandemic Years 2020 - 2021 in Peru

The study aims to determine the influence of the efficiency of the cervical cancer program on the budget execution during the COVID-19 pandemic years 2020- 2021. Estimating the screened women and using a micro-costing analysis to estimate the cost of treating precancerous lesions and cervical cancer in the pandemic and a non-pandemic scenario during 2020 -2021. Finally, the estimation of the budget execution for the cervical cancer program led by the Ministry of Health in the pandemic and non-pandemic scenarios. The estimation in the study was through two scenarios determined, the pandemic and non-pandemic scenarios during the years 2020 and 2021. After that, it was determined the number of screened and non-screened women. The next step was the cost estimation of the low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesions (HSIL), and cervical cancer at different stages. Therefore, this information is necessary for the Peruvian Ministry of Health to provide healthcare services to patients who did not get screened in the years 2020 and 2021. The non-pandemic scenario would be spent USD 33,547,185 and USD 37,428,997 in 2020 and 2021, respectively. Conversely, in the pandemic scenario, spent USD 9,934,440 and USD 23,762,073 by 2020 and 2021. Therefore, by 2020 must be spent 68.7% of the budget, but only had been spent 20.3%. Moreover, in 2021, only 46.7% of the budget was spent when it should be 73.6% of the total budget. Therefore, USD 39,496,476 and USD 27,114,114 were not executed in 2020 and 2021, respectively. A total of USD 66,610,590 was the non-executed budget for the cervical program and needs to be reallocated in the following years to provide healthcare services to the women who did not get access to screening and treatment.

The effect of attendance in the Dutch breast cancer screening program on breast tumor characteristics among migrant women.

In general, migrant women have a lower breast cancer (BC) incidence rate and higher BC mortality than autochthonous women. Further, migrant women show lower participation in the national BC screening program. To further investigate those aspects, we aimed to determine differences in incidence and tumor characteristics between autochthonous and migrant BC patients in Rotterdam, the Netherlands. We selected women diagnosed with BC in Rotterdam during 2012-2015 from the Netherlands Cancer Registry. Incidence rates were calculated by migrant status (i.e., women with or without migration background). Multivariable analyses revealed adjusted odds ratios (OR) and 95% confidence intervals (CI) on the association between migration status and patient and tumor characteristics, additionally stratified by screening attendance (yes/no). In total 1372 autochthonous and 450 migrant BC patients were included for analysis. BC incidence was lower among migrants than among autochthonous women. Overall, migrant women were younger at BC diagnosis (53 vs. 64 years, p<0.001), and had higher risks of positive lymph nodes (OR 1.76, 95% CI 1.33-2.33) and high grade tumors (OR 1.35, 95% CI 1.04-1.75). Especially non-screened migrant women had higher risk of positive nodes (OR 2.73, 95% CI 1.43-5.21). Among the subgroup of screened women, we observed no significant differences between migrant and autochthonous patients. Migrant women have lower BC incidence than autochthonous women, but diagnosis was more often at younger age and with unfavorable tumor characteristics. Attending the screening program strongly reduces the latter. Therefore, promotion of participation in the screening program is recommended.

Screening behaviours, demographics, and stage at diagnosis in the publicly funded Ontario Breast Screening Program

PurposeThe Ontario Breast Screening Program (OBSP) offers free screening mammograms every 2 years, to women aged 50–74. Study objectives were to determine demographic characteristics associated with the adherence to OBSP and if women screened in the OBSP have a lower stage at diagnosis than non-screened eligible women.MethodsWe used the Ontario cancer registry (OCR) to identify 48,927 women, aged 51–74 years, diagnosed with breast cancer between 2010 and 2017. These women were assigned as having undergone adherent screening (N = 26,108), non-adherent screening (N = 6546) or not-screened (N = 16,273) in the OBSP. We used multinomial logistic regression to investigate the demographic characteristics associated with screening behaviour, as well as the association between screening status and stage at diagnosis.ResultsAmong women with breast cancer, those living in rural areas (versus the largest urban areas) had a lower odds of not being screened (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.68, 0.78). Women in low-income (versus high-income) communities were more likely not to be screened (OR 1.42, 95% CI 1.33, 1.51). When stratified, the association between income and screening status only held in urban areas. Non-screened women were more likely to be diagnosed with stage II (OR 1.91, 95% CI 1.82, 2.01), III (OR 2.96, 95% CI 2.76, 3.17), or IV (OR 8.96, 95% CI 7.94, 10.12) disease compared to stage I and were less likely to be diagnosed with ductal carcinoma in situ (DCIS) (OR 0.91, 95% CI 0.84–0.98).ConclusionsThis study suggests that targeting OBSP recruitment efforts to lower income urban communities could increase screening rates. OBSP adherent women were more likely to be diagnosed with earlier stage disease, supporting the value of this initiative and those like it.

Knowledge, perception of HIV symptom severity and cervical cancer screening behaviour among women living with HIV in China.

This study aimed to examine the previous uptake of cervical cancer screening and intention to be screened and its associated factors among women living with HIV in China. We conducted a cross-sectional survey of 213 women living with HIV to collect information about cervical cancer screening behaviour, demographics, knowledge about cervical cancer and screening, and perception of HIV symptom severity. Seventy-eight women living with HIV (36.6%) had undergone cervical cancer screening, and 83 (61.5%) of the nonscreened women had the intention to be screened in the future. Using multivariate analysis, women who had more knowledge about cervical cancer screening (OR = 2.373, 95% CI = 1.593-3.534, p = 0.000) and had at least one nongynecological symptom (OR = 0.446, 95% CI = 0.204-0.978, p = 0.044) were more likely to have received screening previously. This study emphasised that knowledge, as a salient factor, was crucial to promoting cervical cancer screening behaviour among women living with HIV. Effective measures should be taken to promote the knowledge about cervical cancer prevention. A new healthcare model, including preventive healthcare in addition to HIV/AIDS care, may be needed to address the complex needs of women living with HIV in China.

Women’s conceptual knowledge about breast cancer screening and overdiagnosis in Norway: a cross-sectional study

ObjectiveTo investigate conceptual knowledge about mammographic screening among Norwegian women.DesignWe administered a cross-sectional, web-based survey. We used multiple-choice questions and a grading rubric published by a research group from Australia.SettingOur...

Effect of accessibility improvement in a national population-based breast cancer screening policy on mammography utilization among women with comorbid conditions in Taiwan

In Taiwan, a Cancer Screening Quality Improvement Program (CAQIP), implemented in 2010, provides financial support to qualified hospitals to improve accessibility. This study aimed to examine the effect of CAQIP on mammography participation among women aged 50–69 years at various health statuses. A natural experimental study design before and after CAQIP implementation in 2010 was conducted. Phase 1 included 437,875 screened and 1,490,453 non-screened women, and 830,348 and 1,03,454 in Phase 2. Compared with women with no comorbidity, women with severe chronic conditions were less likely to participate in mammography screening. CAQIP was positively associated with the likelihood of mammography participation (OR 3.899, 95% CI 3.878–3.920); the magnitude of the effect was smaller for women with comorbid conditions. The findings provide evidences and economic theorical perspectives of potential benefits of health policy interventions to improve accessibility and mammography participation among women aged 50–69 years with comorbid conditions.

Effectiveness of the Korean National Cancer Screening Program in reducing breast cancer mortality

High incidences of breast cancer (BC) are reported in Asian women in their forties, and it is not clear whether mammographic screening reduces mortality among them. This study evaluated the effect of BC screening on mortality in Korea. We conducted a nationwide prospective cohort study of women invited to the Korean National Cancer Screening Program (KNCSP) between 2002 and 2003 (N = 8,300,682), with data linkage to the Korea Central Cancer Registry and death certificates through 2014 and 2015, respectively. Exposure to mammographic screening was defined using a modified never/ever approach. The primary study outcome was adjusted mortality rate ratio (MRR) for BC among screened and non-screened women estimated by Poisson regression. An adjusted MRR for all cause-death other than BC was examined to account for selection bias in the cohort. BC incidence rates for screened and non-screened women were 84.41 and 82.88 per 100,000 women-years, respectively. BC mortality rates for screened and non-screened women were 5.81 and 13.43 per 100,000 women-years, respectively, with an adjusted MRR for BC of 0.43 (95% CI, 0.41−0.44). The adjusted MRR for all-cause death excluding BC was 0.52 (95% CI, 0.52−0.52). The greatest reduction in BC mortality was noted for women aged 45−54 years, and there was no observable reduction in mortality after the age of 70 years. In conclusion, the KNCSP has been effective in reducing BC mortality among Korean women aged 40−69 years.

The European response to the WHO call to eliminate cervical cancer as a public health problem.

The age‐standardised incidence of cervical cancer in Europe varies widely by country (between 3 and 25/100000 women‐years) in 2018. Human papillomavirus (HPV) vaccine coverage is low in countries with the highest incidence and screening performance is heterogeneous among European countries. A broad group of delegates of scientific professional societies and cancer organisations endorse the principles of the WHO call to eliminate cervical cancer as a public health problem, also in Europe. All European nations should, by 2030, reach at least 90% HPV vaccine coverage among girls by the age of 15 years and also boys, if cost‐effective; they should introduce organised population‐based HPV‐based screening and achieve 70% of screening coverage in the target age group, providing also HPV testing on self‐samples for nonscreened or underscreened women; and to manage 90% of screen‐positive women. To guide member states, a group of scientific professional societies and cancer organisations engage to assist in the rollout of a series of concerted evidence‐based actions. European health authorities are requested to mandate a group of experts to develop the third edition of European Guidelines for Quality Assurance of Cervical Cancer prevention based on integrated HPV vaccination and screening and to monitor the progress towards the elimination goal. The occurrence of the COVID‐19 pandemic, having interrupted prevention activities temporarily, should not deviate stakeholders from this ambition. In the immediate postepidemic phase, health professionals should focus on high‐risk women and adhere to cost‐effective policies including self‐sampling.

Social inequalities in cervical cancer screening: a discrete choice experiment among French general practitioners and gynaecologists

BackgroundCervical cancer screening is effective in reducing mortality due to uterine cervical cancer (UCC). However, inequalities in participation in UCC screening exist, especially according to age and social status. Considering the current situation in France regarding the ongoing organized UCC screening campaign, we aimed to assess general practitioners’ (GPs) and gynaecologists’ preferences for actions designed to reduce screening inequalities.MethodsFrench physicians’ preferences to UCC screening modalities was assessed using a discrete choice experiment. A national cross-sectional questionnaire was sent between September and October 2014 to 500 randomly selected physicians, and numerically to all targeted physicians working in the French region Midi-Pyrénées. Practitioners were offered 11 binary choices of organized screening scenarios in order to reduce inequalities in UCC screening participation. Each scenario was based on five attributes corresponding to five ways to enhance participation in UCC screening while reducing screening inequalities.ResultsAmong the 123 respondents included, practitioners voted for additional interventions targeting non-screened women overall (p < 0.05), including centralized invitations sent from a central authority and involving the mentioned attending physician, or providing attending physicians with the lists of unscreened women among their patients. However, they rejected the specific targeting of women over 50 years old (p < 0.01) or living in deprived areas (p < 0.05). Only GPs were in favour of allowing nurses to perform Pap smears, but both GPs and gynaecologists rejected self-collected oncogenic papillomavirus testing.ConclusionsFrench practitioners tended to value the traditional principle of universalism. As well as rejecting self-collected oncogenic papillomavirus testing, their reluctance to support the principle of proportionate universalism relying on additional interventions addressing differences in socioeconomic status needs further evaluation. As these two concepts have already been recommended as secondary development leads for the French national organized screening campaign currently being implemented, the adherence of practitioners and the adaptation of these concepts are necessary conditions for reducing inequalities in health care.

Barriers and facilitators to cervical cancer screening uptake among women in Nepal – a qualitative study

ABSTRACT The global incidence of cervical cancer is approximately 570,000 cases and 311,000 deaths annually. Almost 90% of cervical cancer deaths occur in low and middle income countries. Screening is the most effective tool in prevention, early diagnosis, and treatment of cervical cancer. Nepal has no national cervical cancer screening programme, and data from 2003 showed that only 2.8% of Nepalese women had ever been screened. We conducted a qualitative study to obtain better insight into barriers and facilitators to cervical cancer screening among women in Nepal to generate data to inform interventions. In February 2019, four focus group discussions with previously screened and non-screened women, and Female Community Health Volunteers and four in-depth interviews with health workers were conducted in Pokhara Metropolitan City. Semi-structured interview guides were used, interviews were audio-recorded, transcribed verbatim, and analyzed using grounded theory approach with open coding. This resulted in five main themes: 1) lack of husband’s support for screening, 2) prevalent stigma and discrimination, 3) lack of awareness about screening options, 4) getting screened, and 5) health care providers. We encourage policymakers and stakeholders apply these findings to improve awareness, access to information, and better screening services in Nepal.

Effectiveness of the Korean National Cancer Screening Program in Reducing Breast Cancer Mortality

Background: High incidences of breast cancer are reported in Asian women in their forties, and it is not clear whether mammographic screening for breast cancer reduces mortality among them. Nevertheless, the Korean National Cancer Screening Program (KNCSP) has implemented breast cancer screening for individuals aged 40 years and older. This study evaluated the effect of breast cancer screening in Korea. Methods: We conducted a prospective cohort of cancer-free Korean women who were invited to participate in the KNCSP between 2002 and 2003. We followed them to identify breast cancer incidence and cancer death by 2014 and 2015, respectively. Information on mammographic screening, breast cancer diagnosis, death, and causes of death was linked by identification numbers. Poisson regression was performed to estimate mortality rate ratios (MRR) for breast cancer among screened to non-screened women. Findings: A total of 8,293,240 women aged 40-79 years were included in the analysis. Breast cancer incidence rates were 84.41 and 82.88 per 100,000 women-years for screened and non-screened women, respectively, with an adjusted rate ratio of 1.09 (95% CI, 1.08-1.11). Breast cancer mortality rates were 5.81 and 13.43 per 100,000 women-years for screened and non-screened women, respectively, with an adjusted MRR of 0.43 (95% CI, 0.41-0.44). The greatest mortality reduction was noted among women aged 45 to 54 years, and there was no observable reduction in mortality after the age of 70 years. Interpretations: The KNCSP for breast cancer has been effective in reducing breast cancer mortality for Korean women aged 40-69 years, doing so by 22%. Funding Statement: This study was supported by a Grant-in-Aid for Cancer Research and Control from the National Cancer Center of Korea (1910231-1). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study was approved by the Institutional Review Board of the National Cancer Center, Korea (Institutional Review Board no. NCCNCS08129).

1048P - Quantifying the effects of the Korean national cancer screening program on cervical cancer mortality

BackgroundOrganized cervical cancer screening program for women aged 30 or over using Pap Smear has been launched in Korea since 1999. However, there is limited evidence showing the effectiveness of this nationwide screening program in reducing cervical cancer mortality. In this study, we aim to examine cervical cancer mortality among screened and non-screened women who participated in the Korean National Cancer Screening Program (KNCSP) from 2002 to 2003. MethodsWe conducted a prospective cohort study of women aged 30-79 years invited to the KNCSP between 2002 - 2003 and followed up to 2015 for deaths from cervical cancer and other causes. Women with incomplete ID, diagnosed with cervical cancer before entering the cohort, or older than 79 years were excluded. Finally, a total of 8,262,267 women aged 30-79 were included, and their cervical cancer screening exposure, cancer incidence, and death information were collected from the KNCSP database, National Cancer Registry, and death certificate from Statistics Korea. There were 6,615,614 women in the screen group (mean person-year: 9.74) and 5,814,989 women in the non-screen group (mean person-year: 8.33). Incidence rate ratio (IRR) and Mortality rate ratio (MRR) were used to compare between screen and non-screen cohorts using Poisson regression model. The MRRs and IRRs were adjusted for age at inclusion in the cohort, insurance type, and self-selection bias. ResultsThe crude mortality rate was 3.49 and 8.77 per 100,000 women-years for screen and non-screen group, respectively. MRR for cervical cancer was 0.46 (95% confidence interval (CI): 0.44-0.48). After adjusting for self-selection bias, it was estimated that there was 36.11% of mortality reduction in screen group compared to non-screen group. Also, IRR of invasive cancer in screen group was 0.74 (95% CI: 0.72-0.76) compared to non-screen group. However, there was no significant reduction in the total number of invasive cervical cancer and cervical cancer in situ incidence rate (IRR: 0.98; 95%CI: 0.98 (0.96-1.00)). ConclusionsWe found that after 13 years of follow-up, 36.11% of cervical cancer mortality reduction was observed among women who attended the Korean National Cervical Cancer Screening Program. Legal entity responsible for the studyKui Son Choi. FundingNational Cancer Center, Korea (Grant number: 1610401) and International Cooperation & Education Program (NCCRI·NCCI 52210-52211,2019) of National Cancer Center, Korea. DisclosureAll authors have declared no conflicts of interest.

Role of participation in organized screening on the survival of women with breast cancer according to socioeconomic disparities: A population-based study

Several observational studies have suggested the impact of socioeconomic disparities in breast cancer diagnosis. Living in a deprived area was associated to advanced tumor stage at diagnosis and poor prognosis. The participation in organized breast cancer screening (OBCS) program can help to detect cancers at an early stage and to reduce mortality. This study aimed at describing survival of women with cancer according to their participation in OBCS and socioeconomic characteristics in the department of Gironde. All cases of breast cancer in situ or invasive diagnosed over the period 2008–2010, in women aged 50 to 74 years were extracted from Gironde Cancer Registry. The participation in OBCS program was obtained from the Gironde Screening Coordination Structure (AGIDECA). Women were categorized in 4 groups according their participation in the OBCS. The socioeconomic environment was measured by an aggregated indicator of deprivation: the French European Deprivation Index (EDI). EDI was categorized in quintiles (quintile 1: women most affluent and quintile 5: women most deprived). We estimated net survival rates at 1 and 5 years using the Pohar-Perme method according to the participation in OBCS and socioeconomic deprivation. A correction of the advance bias at diagnosis (or lead time bias) was taken into account by modifying the survival time of the screened women according a method established by Duffy et al. During the 2008–2010 period, 2,244 women were diagnosed with first breast cancer in Gironde department. In this population, 297 deaths were reported. Among all these women, 57% had participated in OBCS, 24% were non-screened, 14% had interval cancer (cancer diagnosed between 2 screening test) and 5% were diagnosed more than 2 years after the last screening test. Net survival was higher in the group of screen-detected women compared to non-screened women (97.3% vs. 83.8%, P < 0.0001). Non-screened women had lower net survival when they were deprived (quintile 1: 91.1% vs. quintile 5: 78.1%, P < 0.0106). Taking into account socioeconomic disparities, survival was higher for screened women than for non-screened women, but the difference was significant only in most deprived areas (quintiles 3 to 5). After correction for the bias in advance of diagnosis, the survival rates of screen-detected women were lower than without correction, but they remained higher than those of women who were not screened. Women with breast cancer participating in OBCS in Gironde had better net survival at five years compared to women who were non-screened. The role of OBCS on breast cancer survival seemed to be stronger for women in most deprived areas. The implementation of incentive actions in deprived areas in order to foster women to participate in OBCS could improve their survival in case of breast cancer diagnosis.

Is the incidence of advanced-stage breast cancer affected by whether women attend a steady-state screening program?

In this cross-sectional population-based study, we assessed the incidence of advanced breast cancer based on screening attendance. Women from the Netherlands Cancer Registry were included if aged ≥49 years and diagnosed with breast cancer between 2006 and 2011, and data were linked with the screening program. Cancers were defined as screen-related (diagnosed <24 months after screening) or nonscreened (all other breast cancers). Two cut-offs were used to define advanced breast cancer: TNM-stage (III-IV vs 0-I-II) and T-stage alone (≥15 mm vs <15 mm or DCIS). The incidence rates were adjusted for age and logistic regression was used to compare groups. Of the 72,612 included women diagnosed with breast cancer, 44,246 (61%) had screen-related breast cancer. By TNM stage, advanced cancer was almost three times as likely to be at an advanced TNM stage in the nonscreened group compared with the screen-related group (38 and 94 per 100,000, respectively; OR: 2.86, 95%CI: 2.72-3.00). By T-stage, the incidence of advanced cancer was higher overall, and in nonscreened women was significantly higher than in screened women (210 and 169 per 100,000; OR: 1.85, 95%CI: 1.78-1.93). Data on actual screening attendance showed that the incidence of advanced breast cancer was significantly higher in nonscreened women than in screened women, supporting the expectation that screening would cause a stage shift to early detection. Despite critical evaluations of breast cancer screening programs, our data show that breast cancer screening is a valuable tool that can reduce the disease burden in women.

Understanding the cervical screening behaviour of Chinese women: The role of health care system and health professions

BackgroundIn China, cervical cancer cases are increasing, making an impact on the worldwide burden of cervical cancer. Despite the initiatives undertaken by the Chinese government, the current coverage of cervical screening in China remains suboptimal. There is an urgent need to identify the facilitators and barriers associated with the uptake of cervical cancer screening among the Chinese population. PurposeThe study aimed to explore the experiences and perceptions of cervical cancer screening of mainland Chinese women in relation to their screening behaviour, particularly in the aspects of health care system and health profession roles. MethodsA qualitative research was conducted using semi-structured interviews. A total of 27 Chinese women aged 25 to 50 (both screened and non-screened women) completed the interviews. The analysis of the interview data was undertaken inductively using latent content analysis. Discussion and conclusionResults showed that organised health examination programmes provide a good basis for integrating cervical screening into broader checks on the health of women, and utilising different networks of social support facilitate the utilisation of the screening service. However, education on cervical cancer and screening must be made more generally available. More importantly, there is a need for a more participatory and empowering exchange in the encounter between health professions and these women. Appropriate training program is strongly recommended for health professions about communicate skills with patients. Future work should focus on identifying strategies to overcome the barriers to cervical screening related to health care system and medical professions among this population.

Are there regional tendencies toward controversial screening practices? A study of prostate and breast cancer screening in a Medicare population

IntroductionProstate and breast cancer screening in older patients continue to be controversial. Balancing the desire for early detection with avoidance of over-diagnosis has led to competing and contradictory guidelines for both practices. Despite similarities, it is not known how these screening practices are related at the regional level. In this study, we examined how screening PSA and mammography are related within healthcare regions, and, to better understand what may be driving these practices, whether they are associated with local intensity of care. MethodsWe performed a retrospective cross-sectional study of fee-for-service Medicare beneficiaries in 2012. For each of 306 hospital referral regions (HRRs), we calculated rates of PSA screening for men aged ≥68 years, as well as rates of screening mammography for women aged ≥75 years, adjusted for age and race. Additionally, we determined regional rates of “healthcare intensity”, including spending on tests and procedures, and intensity of end-of-life care. Pearson correlations of adjusted rates were calculated within HRRs. ResultsThe mean adjusted rate of PSA screening was 22%. The mean age of screened and unscreened patients was 75.0 and 77.4 years, respectively (p<0.0001). The mean adjusted rate of screening mammography was 23%; mean ages of screened and non-screened women were 79.95 and 83.67, respectively (p<0.0001). HRR-level PSA screening rates were independent of screening mammography rates (r=0.06, p=0.31). PSA screening rates were associated with spending on testing and procedures (r=0.42, p<0.0001) and various measures of intensity of EOL care (e.g. r=0.40, p<0.0001 for mechanical ventilator use). Screening mammography had low correlation with both health care spending and EOL care intensity measures (all r-values <0.3). ConclusionsRegional rates of PSA screening rates were independent of screening mammography, thus these practices appear to be driven by different factors. Unlike mammography, PSA screening was associated with local enthusiasm for testing and treatment. Efforts to reduce over-testing should contemplate these practices differently, and future research should examine the factors motivating these screening practices.