Surveillance for equity in cervical cytology screening

Social disparities in breast and cervical cancer preventive practices

Knowledge of factors related to the use of preventive practices is essential in order to build strategies to decrease cancer incidence and mortality. The aim of this study is to describe the characteristics of women who periodically use cervical smear and mammography. This is a cross-sectional study based on the 2001 Balearic Health Survey, using a stratified sample of non-institutionalized population resident in the Balearic Islands. The study included 560 women, aged 20 years or over. The variables studied were age, marital status, social class, education, place of residence and birth, self-perceived health status, satisfaction with health services, job status and type of medical coverage. A multivariate analysis was performed using logistic regression models. Thirty-five per cent had regular mammography (72% between 50 and 64 years) and 54% had cervical smears. The probability of having undergone mammography is higher in women between the ages of 50 and 64 years [odds ratio (OR)=11.74; interval confidence (IC): 5.89-23.39] and in those with additional medical coverage (OR=1.97; IC: 1.19-3.27) and much lower in single women (OR=0.22; IC: 0.10-0.49). The probability of having undergone a Pap test increases according to educational level (OR=2.25; IC: 0.98-5.18 for women in the higher level) and social class (OR=1.98; IC: 0.91-4.28 for social class I) and decreases in women older than 65 years (OR=0.15; IC: 0.07-0.35) and in single women (OR=0.29; IC: 0.16-0.50). Age and marital status are factors related to both practices. Socio-economic status remains associated with cervical smear use, while having an additional medical coverage increases the probability of regular mammography.

Comparison of a community outreach service with opportunity screening for cervical cancer using Pap smears

We sought to compare the take-up of cervical screening with Pap smears in a new outreach and pre-existing hospital-based setting (1) to assess the extent to which the two means of provision would overlap; (2) to establish how the utilization rate is influenced by demographic features and geographical distance from the point of provision; and (3) to access whether an outreach service would lead to increased utilization. We used a pre-test-post-test design and used multiple linear regression to assess the effect an outreach service has on utilization after adjusting for participants age, education and martial status. We found that the outreach service independently provided screening to 89% of eligible women and that coverage was inversely associated with distance from the pre-existing hospital provision. After controlling for age, education and martial status, there was a statistically significant increase (53%; 95% CI: 25, 80%) in utilization. There was little overlap between the outreach and hospital-based cervical screening services so that overall accessibility was enhanced, particularly for the elderly, widowed and less well educated. The outreach service also reduced inequalities due to geography.

Cervical cancer screening in developing countries: why is it ineffective? The case of Mexico

BACKGROUND

Mexico established a national cervical cancer-screening program in 1974. Despite the implementation of the program, there was a steady mortality trend of 16 per 100,000 women over 15 years.

METHODS

A diagnostic procedure of the pitfalls was applied to the following steps of the screening procedure: Pap sampling quality; cytological diagnosis validity; compliance of women; and determinants of non-participation.

RESULTS

The low effectiveness of screening on cervical cancer is principally due to factors associated with quality and coverage. Pap quality is deficient; 64% of a random sample of specimens lacked endocervical cells. Reading centers presented false negative indices of between 10 and 54%. Women seek screening in a late stage of disease (55% with cervical cancer seek care because they have symptoms). In addition, coverage is low; in women between 15 and 49 years of age in Mexico City, 64.2% have a history of Pap, compared with 30% in rural areas. Knowledge of what the Pap is used for strongly determines the use of screening. In rural areas, only 40% of women are informed about the purpose of the Pap test.

CONCLUSIONS

A proposal to reorganize Mexico's screening program includes the following five main strategies: (a) increased coverage; (b) improved quality control of how cervical smears are taken; (c) better interpretation of Pap tests; (d) guaranteed treatment for those whose tests show abnormalities, and (e) improved follow-up.

Cancer mortality by educational level in the city of Barcelona

The objective of this study was to examine the relationship between educational level and mortality from cancer in the city of Barcelona. The data were derived from a record linkage between the Barcelona Mortality Registry and the Municipal Census. The relative risks (RR) of death and 95% confidence intervals (CIs) according to level of education were derived from Poisson regression models. For all malignancies, men in the lowest educational level had a RR of death of 1.21 (95% CI 1.13-1.29) compared with men with a university degree, whereas for women a significant decreasing in risk was observed (RR 0.81; 95% CI 0.74-0.90). Among men, significant negative trends of increasing risk according to level of education were present for cancer of the mouth and pharynx (RR 1.70 for lowest vs. highest level of education), oesophagus (RR 2.14), stomach (RR 1.99), larynx (RR 2.56) and lung (RR 1.35). Among women, cervical cancer was negatively related to education (RR 2.62), whereas a positive trend was present for cancers of the colon (RR 0.76), pancreas (RR 0.59), lung (RR 0.55) and breast (RR 0.65). The present study confirms for the first time, at an individual level, the existence of socioeconomic differences in mortality for several cancer sites in Barcelona, Spain. There is a need to implement health programmes and public health policies to reduce these inequities.