1
|
Suurna M, Orumaa M, Ringmets I, Pärna K. Inequalities in reported use of cervical screening in Estonia: results from cross-sectional studies in 2004-2020. BMC Womens Health 2022; 22:545. [PMID: 36566176 PMCID: PMC9789641 DOI: 10.1186/s12905-022-02123-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Despite the national cervical cancer (CC) screening program established in 2006, the CC incidence in Estonia in 2020 was still one of the highest in Europe. To better understand the possible barriers among women, the aim of this study was to describe the inequalities in the Pap smear uptake trend in 2004-2020 and to analyse the associations between different factors in Estonia. METHODS Weighted data of 25-64-year-old women (N = 6685) from population-based cross-sectional studies of Health Behaviour among Estonian Adult Population in 2004-2020 was used. Linear trends in uptake of Pap smear over time were tested using the Cochrane-Armitage test. Binary logistic regression with interactions was performed to analyse associations between the uptake of Pap smear and sociodemographic, socioeconomic, health-related and lifestyle factors. Crude and adjusted odds ratios with 95% confidence intervals were calculated. RESULTS Prevalence of lifetime uptake of Pap smear increased in 2004-2020 from 50.6 to 86.7% (P < 0.001). From 2004 to 2020, uptake of Pap smear increased significantly among women aged 25-34, 35-44, 45-54 and 55-64, in both ethnicity groups and among women with basic, secondary and higher education (P < 0.001). The gap in Pap smear uptake increased between Estonians and non-Estonians but decreased between education levels over time. Lower lifetime uptake of Pap smear was associated from sociodemographic factors with younger age, being non-Estonian and single, from socioeconomic factors with lower educational level and unemployment, from health indicators with higher body mass index indicating overweight and obesity, presence of chronic disease and depressiveness, and from lifestyle factors with non-smoking. CONCLUSIONS Although Pap smear uptake among 25-64 year old women increased significantly in Estonia in 2004-2020, inequalities were found indicating an opportunity for development of targeted CC prevention strategies.
Collapse
Affiliation(s)
- Maria Suurna
- grid.416712.70000 0001 0806 1156Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia
| | - Madleen Orumaa
- grid.416712.70000 0001 0806 1156Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia ,grid.418941.10000 0001 0727 140XDepartment of Research, Cancer Registry of Norway, Oslo, Norway
| | - Inge Ringmets
- grid.10939.320000 0001 0943 7661Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia
| | - Kersti Pärna
- grid.10939.320000 0001 0943 7661Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia
| |
Collapse
|
2
|
Samman E, Mkuu R, Zhang X, Scummings S, Burdine J. Body Mass Index and Breast and Cervical Cancer Screening. WOMEN'S HEALTH REPORTS 2022; 3:508-514. [PMID: 35651991 PMCID: PMC9148662 DOI: 10.1089/whr.2021.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/20/2022]
Abstract
Background: Breast and cervical cancer screening are responsible for dramatically reducing cancer deaths. Overweight and obesity are associated with deleterious health outcomes, including increased risk of developing cancer. This study adds to the existing literature examining the association of having overweight and obesity and receipt of breast or cervical cancer screening. Methods: Using the 2013 Brazos Valley Community Health Needs Assessment, we examined the association between body mass index (BMI) and receipt of breast or cervical cancer screening among women meeting age recommendations for breast cancer and cervical cancer screening (n = 1979 and n = 2040), respectively. We used SPSS 22 statistical software for descriptive and logistic regression analysis. Results: Overall, 26.6% of women missed the breast cancer screening guidelines, and 13.3% missed the cervical cancer screening guidelines. BMI had a weak association with missing cervical cancer screenings (odds ratio [OR] = 1.02; confidence interval [CI] = 1.01–1.04), but no association with missing breast cancer screenings (OR = 1.01; CI = 0.99–1.03). Higher age, race (non-White), rural area, no health insurance, smoking, and delayed health care were associated with missing breast cancer screenings. Higher age, marital status (single), lower education, no health insurance, smoking, and delayed health care were associated with missing cervical cancer screening. Further research is needed to better understand the association using larger, more diverse samples.
Collapse
Affiliation(s)
- Elfreda Samman
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Rahma Mkuu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida Gainesville, Florida, USA
| | - Xiaoying Zhang
- Department of Health and Kinesiology, College of Education & Human Development, Texas A&M University, USA
| | - Shelby Scummings
- Department of Statistics, College of Science, Texas A&M University, USA
| | - James Burdine
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, Texas, USA
| |
Collapse
|
3
|
Graham Y, Hayes C, Cox J, Mahawar K, Fox A, Yemm H. A systematic review of obesity as a barrier to accessing cancer screening services. Obes Sci Pract 2022; 8:715-727. [DOI: 10.1002/osp4.606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 03/28/2022] [Accepted: 04/06/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Yitka Graham
- Faculty of Health Sciences and Wellbeing School of Nursing and Health Sciences Helen McArdle Nursing and Care Research Institute Sunderland UK
- Department of General Surgery South Tyneside and Sunderland NHS Foundation Trust Sunderland UK
- Sunderland Clinical Commissioning Group Sunderland UK
- Faculty of Psychology University of Anahuac Mexico City Mexico
| | - Catherine Hayes
- Faculty of Health Sciences and Wellbeing School of Nursing and Health Sciences Helen McArdle Nursing and Care Research Institute Sunderland UK
| | - Julie Cox
- Faculty of Health Sciences and Wellbeing School of Nursing and Health Sciences Helen McArdle Nursing and Care Research Institute Sunderland UK
- Department of Radiology South Tyneside and Sunderland NHS Foundation Trust Sunderland UK
| | - Kamal Mahawar
- Faculty of Health Sciences and Wellbeing School of Nursing and Health Sciences Helen McArdle Nursing and Care Research Institute Sunderland UK
- Department of General Surgery South Tyneside and Sunderland NHS Foundation Trust Sunderland UK
| | - Ann Fox
- Faculty of Health Sciences and Wellbeing School of Nursing and Health Sciences Helen McArdle Nursing and Care Research Institute Sunderland UK
- Sunderland Clinical Commissioning Group Sunderland UK
| | - Heather Yemm
- Faculty of Health Sciences and Wellbeing School of Nursing and Health Sciences Helen McArdle Nursing and Care Research Institute Sunderland UK
| |
Collapse
|
4
|
Grimley CE, Kato PM, Grunfeld EA. Health and health belief factors associated with screening and help-seeking behaviours for breast cancer: A systematic review and meta-analysis of the European evidence. Br J Health Psychol 2019; 25:107-128. [PMID: 31876992 DOI: 10.1111/bjhp.12397] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 10/28/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this systematic review was to identify health or health belief factors associated with mammography attendance or with self-initiated medical help-seeking for breast cancer symptoms among women in Europe. METHODS Five databases were searched for articles published between 2005 and 2018. Meta-analyses were conducted for 13 factors related to screening attendance and two factors associated with help-seeking behaviour. Where there were too few studies to include in the meta-analysis, a narrative synthesis was undertaken. RESULTS Sixty-five studies were included. Never having had cervical screening (d = -.72, p < .001) and higher perceived barriers to mammography (d = -.40, p < .001) were associated with lower levels of screening attendance. Possessing health insurance (d = .49, p < .001), greater perceived benefits (d = .31, p < .001) and motivation (d = .36, p = .003) towards screening, and higher perceived seriousness (d = .24, p = .019) and susceptibility (d = .20, p = .024) towards breast cancer were associated with a higher level of screening attendance. Presenting with a non-lump symptom was associated with a longer time to presentation (d = .32, p < .001). The narrative synthesis revealed that previous benign breast disease was associated with a higher level of screening attendance but with a longer time to presentation. CONCLUSIONS The review identified key similarities in factors associated with screening and help-seeking behaviours which offer scope for combined interventions aimed at women that target both behaviours. Furthermore, the review highlighted that fewer studies have focused on help-seeking behaviour, despite two thirds of breast cancer cases being self-detected. Future research should further examine predictors of help-seeking behaviour including a focus on modifiable factors, such as BMI, and physical activity.
Collapse
Affiliation(s)
| | - Pamela M Kato
- P. M. Kato Consulting, Mountain View, California, USA
| | - Elizabeth A Grunfeld
- Department of Psychological Sciences, Birkbeck College, University of London, UK
| |
Collapse
|
5
|
Aminisani N, Fattahpour R, Dastgiri S, Asghari-Jafarabadi M, Allahverdipour H. Determinants of breast cancer screening uptake in Kurdish women of Iran. Health Promot Perspect 2016; 6:42-6. [PMID: 27123436 PMCID: PMC4847114 DOI: 10.15171/hpp.2016.07] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/25/2016] [Indexed: 02/04/2023] Open
Abstract
Background: Recently, a national breast cancer screening program has been
introduced in Iran.The aim of this study was to examine the determinants of breast cancer
screening uptake among Kurdish women, in order to identify those characteristics that may
be potentially associated with the screening uptake. Methods: Through a cross sectional study, in 2014, a random sample of 561
women aged 40 years and older without the history of breast cancer and identified with
Kurdish background in Baneh county, Iran, were recruited and interviewed by two trained
interviewers. Data were collected using a valid and reliable researcher made
questionnaire. Univariate and multivariate logistic regression models with self-reported
screening history as the dependent variable were used to estimate the odds ratios (ORs)
with 95% of CI. Results: The mean age of women was 43.64 (SD = 5.17). The participation rate
in the mammography program was 16.8% (95% CI: 13.7-19.8%). The lowest level of
participation was found among women aged 60 and older (OR = 0.30, 95% CI: 0.14-0.69),
illiterate (OR = 0.63,95% CI: 0.40-0.99) and post-menopausal (OR = 0.56, 95% CI:
0.35-0.91) women. Conclusion: It was found that the level of breast screening uptake was low
among Kurdish women compared to those reported in the previous studies. Designing
participation enhancing interventions with a specific focus on older, illiterate and
post-menopausal women are recommended.
Collapse
Affiliation(s)
- Nayyereh Aminisani
- Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Roujin Fattahpour
- Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeed Dastgiri
- Tabriz Health Services Management Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Hamid Allahverdipour
- Clinical Psychiatry Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
6
|
Ricardo-Rodrigues I, Jiménez-García R, Hernández-Barrera V, Carrasco-Garrido P, Jiménez-Trujillo I, López de Andrés A. Social disparities in access to breast and cervical cancer screening by women living in Spain. Public Health 2015; 129:881-8. [PMID: 25818014 DOI: 10.1016/j.puhe.2015.02.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 12/07/2014] [Accepted: 02/15/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To describe uptake of breast and cervical cancer screening by women living in Spain, analyse the possible associated social and health factors, and compare uptake rates with those obtained in previous surveys. STUDY DESIGN Cross-sectional study using data from the 2011 Spanish national health survey. METHODS Uptake of breast cancer screening was analysed by asking women aged 40-69 years whether they had undergone mammography in the previous two years. Uptake of cervical cancer screening was analysed by asking women aged 25-65 years whether they had undergone cervical cytology in the previous three years. Independent variables included sociodemographic characteristics, and variables related to health status and lifestyle. RESULTS Seventy-two percent of women had undergone mammography in the previous two years. Having private health insurance increased the probability of breast screening uptake four-fold [odds ratio (OR) 3.96, 95% confidence interval (CI) 2.71-5.79], and being an immigrant was a negative predictor for breast screening uptake. Seventy percent of women had undergone cervical cytology in the previous three years. Higher-educated women were more likely to have undergone cervical cancer screening (OR 2.59, 95% CI 1.97-3.40), and obese women and women living in rural areas were less likely to have undergone cervical cancer screening. There have been no relevant improvements in uptake rates of either breast or cervical cancer screening since 2006. CONCLUSION Uptake of breast and cervical cancer screening could be improved in Spain, and uptake rates have stagnated over recent years. Social disparities have been detected with regard to access to these screening tests, indicating that it is necessary to continue researching and optimizing prevention programmes in order to improve uptake and reduce these disparities.
Collapse
Affiliation(s)
- I Ricardo-Rodrigues
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcórcon, Spain
| | - R Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcórcon, Spain.
| | - V Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcórcon, Spain
| | - P Carrasco-Garrido
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcórcon, Spain
| | - I Jiménez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcórcon, Spain
| | - A López de Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcórcon, Spain
| |
Collapse
|
7
|
Miller S, Rafanan L, Keihany S, Reyes-Ortiz CA. The relationship between body mass index and cancer screening utilization among older women in Latin American and Caribbean cities. J Women Aging 2015; 27:3-16. [PMID: 25551260 DOI: 10.1080/08952841.2014.905403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To examine the relationship between body mass index and cancer screening utilization, we analyzed data from six cities of the Health, Well-Being and Aging in Latin America and the Caribbean Study on 5,230 women aged 60 and older, from 1999 to 2000. We found that underweight women were less likely to have had a mammogram, a breast self-exam, and a Pap smear, relative to normal-weight women. However, overweight or obese women were more likely to have a breast self-exam and a Pap smear. Thus, being underweight had a role for decreased cancer screening utilization among older women in Latin American cities, but not being overweight or obese, which was associated with decreased cancer screening in most previous studies.
Collapse
Affiliation(s)
- Stephen Miller
- a Texas College of Osteopathic Medicine , Fort Worth , TX
| | | | | | | |
Collapse
|
8
|
Vals K, Kiivet RA, Leinsalu M. Alcohol consumption, smoking and overweight as a burden for health care services utilization: a cross-sectional study in Estonia. BMC Public Health 2013; 13:772. [PMID: 23968192 PMCID: PMC3765337 DOI: 10.1186/1471-2458-13-772] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 08/20/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Alcohol consumption, smoking and weight problems are common risk factors for different health problems. We examine how these risk factors are associated with the use of health care services. METHODS Data for 6500 individuals in the 25-64 age group came from three cross-sectional postal surveys conducted in 2004, 2006, and 2008 in Estonia. The effect of alcohol consumption, smoking and weight problems on the use of primary and specialist care services, hospitalizations and ambulance calls was analysed separately for men and women by using binary logistic regression. RESULTS Overweight and/or obesity were strongly related to the use of primary care and out-patient specialist services for both genders, and to hospitalizations and ambulance calls for women. Current smoking was related to ambulance calls for both genders, whereas smoking in the past was related to the use of primary care and specialist services among men and to hospitalizations among women. Beer drinking was negatively associated with all types of health care services and similar association was found between wine drinking and hospitalizations. Wine drinking was positively related to specialist visits. The frequent drinking of strong alcohol led to an increased risk for ambulance calls. Drinking light alcoholic drinks was positively associated with all types of health care services (except ambulance calls) among men and with the use of specialist services among women. CONCLUSIONS Overweight and smoking had the largest impact on health care utilization in Estonia. Considering the high prevalence of these behavioural risk factors, health policies should prioritize preventive programs that promote healthy lifestyles in order to decrease the disease burden and to reduce health care costs.
Collapse
Affiliation(s)
- Kaire Vals
- Department of Public Health, University of Tartu, Ravila 19, Tartu 50411, Estonia
- Infectious Diseases and Drug Monitoring Department, National Institute for Health Development, Tallinn, Estonia
| | - Raul-Allan Kiivet
- Department of Public Health, University of Tartu, Ravila 19, Tartu 50411, Estonia
| | - Mall Leinsalu
- Stockholm Centre on Health of Societies in Transition, Södertörn University, Stockholm, Sweden
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| |
Collapse
|