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Altová A, Kulhánová I, Reisser K, Netrdová P, Brož J, Eikemo TA, Balaj M, Lustigová M. Educational inequalities in cervical cancer screening participation in 24 European countries. Public Health 2024; 233:1-7. [PMID: 38805834 DOI: 10.1016/j.puhe.2024.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/10/2024] [Accepted: 04/25/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVES Cervical cancer screening (CCS) is an important public health measure for early detection of cervical cancer and prevents a large proportion of cervical cancer deaths. However, participation in CCS is relatively low and varies substantially by country and socio-economic position. This study aimed to provide up-to-date participation rates and estimates on educational inequalities in CCS participation in 24 European countries with population-based CCS programmes. STUDY DESIGN This was a cross-sectional study. METHODS Using data from the European Health Interview Survey (EHIS) conducted in 2019, 80,479 women aged 25-64 years were included in the analyses. First, standardized participation rates and standardized participation rates by educational attainment were calculated for all 24 countries based on each country-specific screening programme organization. Second, a series of generalized logistic models was applied to assess the effect of education on CCS participation. RESULTS Screening participation rates ranged from 34.1% among low-educated women in Romania to 97.1% among high-educated women in Finland. We observed that lower-educated women were less likely to attend CCS than their higher-educated counterparts. Largest educational gaps were found in Sweden (odds ratio [OR] = 6.36, 95% confidence interval [CI] = 3.89-10.35) and Poland (odds ratio = 5.80, 95% CI = 4.34-7.75). CONCLUSION Population-based screening initiatives have successfully reduced participation differences between women with medium and high educational attainment in some countries; however, persistent disparities still exist between women with low and high levels of education. There is an urgent need to increase participation rates of CCS, especially among lower-educated women.
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Affiliation(s)
- A Altová
- Department of Demography and Geodemography, Faculty of Science, Charles University, Albertov 6, Praha 2, 12800, Czech Republic.
| | - I Kulhánová
- Department of Demography and Geodemography, Faculty of Science, Charles University, Albertov 6, Praha 2, 12800, Czech Republic; Department of Social Geography and Regional Development, Faculty of Science, Charles University, Albertov 6, Praha 2, 12800, Czech Republic
| | - K Reisser
- Faculty of Medicine, Leipzig University, Liebigstraße, 04103, Leipzig, Germany; Faculty of Health, Medicine, and Life Sciences, Maastricht University, Minderbroedersberg 4-6, 6211 LK Maastricht, the Netherlands
| | - P Netrdová
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Albertov 6, Praha 2, 12800, Czech Republic
| | - J Brož
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, V Úvalu 84, Praha 5, 150 06, Czech Republic
| | - T A Eikemo
- Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology, Edvard Bulls veg 17049 Trondheim, Norway
| | - M Balaj
- Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology, Edvard Bulls veg 17049 Trondheim, Norway
| | - M Lustigová
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Albertov 6, Praha 2, 12800, Czech Republic; National Institute of Public Health, Šrobárova 49/48, Praha 10, 100 00, Czech Republic
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Zheng S, Zhang X, Greuter MJW, de Bock GH, Lu W. Willingness of healthcare providers to perform population-based cancer screening: a cross-sectional study in primary healthcare institutions in Tianjin, China. BMJ Open 2024; 14:e075604. [PMID: 38569674 PMCID: PMC10989173 DOI: 10.1136/bmjopen-2023-075604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 03/17/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE To evaluate the willingness of healthcare providers to perform population-based screening in primary healthcare institutions in China. METHODS Healthcare providers of 262 primary healthcare institutions in Tianjin were invited to fill out a questionnaire consisting of demographic characteristics, workload, and knowledge of, attitude towards and willingness to perform breast, cervical and colorectal cancer screening. Willingness to screen was the primary outcome. Multilevel logistic regression models were conducted to analyse the determinants of healthcare providers' willingness to screen. ORs and 95% CIs were estimated. RESULTS A total of 554 healthcare providers from 244 institutions answered the questionnaire. 67.2%, 72.1% and 74.3% were willing to perform breast, cervical and colorectal cancer screening, respectively. A negative attitude towards screening was associated with a low willingness for cervical (OR=0.27; 95% CI 0.08, 0.94) and colorectal (OR=0.08; 95% CI 0.02, 0.30) cancer screening, while this was not statistically significant for breast cancer screening (OR=0.30; 95% CI 0.08, 1.12). For breast, cervical and colorectal cancer screening, 70.1%, 63.8% and 59.0% of healthcare providers reported a shortage of staff dedicated to screening. A perceived reasonable manpower allocation was a determinant of increased willingness to perform breast (OR=2.86; 95% CI 1.03, 7.88) and colorectal (OR=2.70; 95% CI 1.22, 5.99) cancer screening. However, this was not significant for cervical cancer screening (OR=1.76; 95% CI 0.74, 4.18). CONCLUSIONS In China, healthcare providers with a positive attitude towards screening have a stronger willingness to contribute to cancer screening, and therefore healthcare providers' attitude, recognition of the importance of screening and acceptable workload should be optimised to improve the uptake of cancer screening.
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Affiliation(s)
- Senshuang Zheng
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - Xiaorui Zhang
- Department of Epidemiology and Health Statistics, Capital Medical University, Beijing, China
| | - Marcel J W Greuter
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wenli Lu
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
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Andrzejczak A, Rucińska M, Żarłok E, Osowiecka K. Health care system and patient-related factors affecting low cancer screening participation in Poland. Prev Med Rep 2023; 36:102442. [PMID: 37822981 PMCID: PMC10562866 DOI: 10.1016/j.pmedr.2023.102442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023] Open
Abstract
The level of participation in cancer screening is low in the Polish population. The aim of this study was to assess the opinions of centers providing cancer screening as to the reasons for the low frequency of cancer screening in Poland and possible methods to increase participation. In July 2020 433 centers in Poland carried out breast and/or cervical cancer screening. Of these, 136 centers decided to participate in the study. The study was conducted using an original questionnaire. The questions were addressed to opinion of centers about: reasons for the low frequency of cancer screening in Poland, methods to increase the frequency of cancer screening, pricing and motivating factors for providing cancer screening. Among opinions as to possible reasons for the low frequency of cancer screening in Poland related to the care-system, lack of encouragement from general practitioners, lack of invitations for cancer screening and lack of proper social advertising were most prevalent; whereas among reasons related to patients, a low awareness of cancer screening and fear of cancer diagnosis. The main methods that could potentially increase screening participation are considered to be the inclusion of cancer screening in mandatory periodic employee examinations, more activity by general practitioners, better promotion of screening by central institutions, and sending personal invitations. In conclude some interventions should be carried out to motivate people to break down barriers.
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Affiliation(s)
- A. Andrzejczak
- Fundacja Onkologia 2025, Al. gen. Sikorskiego 9B lok 12D, Warszawa, Poland
| | - M. Rucińska
- Department of Oncology, Collegium Medicum University of Warmia and Mazury in Olsztyn, Wojska Polskiego 37, 10-228 Olsztyn, Poland
| | - E. Żarłok
- Fundacja Onkologia 2025, Al. gen. Sikorskiego 9B lok 12D, Warszawa, Poland
| | - K. Osowiecka
- Department of Psychology and Sociology of Health and Public Health, School of Public Health, University of Warmia and Mazury in Olsztyn, Warszawska 30, 10-082 Olsztyn, Poland
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Poon C, Wilsdon T, Sarwar I, Roediger A, Yuan M. Why is the screening rate in lung cancer still low? A seven-country analysis of the factors affecting adoption. Front Public Health 2023; 11:1264342. [PMID: 38026274 PMCID: PMC10666168 DOI: 10.3389/fpubh.2023.1264342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Strong evidence of lung cancer screening's effectiveness in mortality reduction, as demonstrated in the National Lung Screening Trial (NLST) in the US and the Dutch-Belgian Randomized Lung Cancer Screening Trial (NELSON), has prompted countries to implement formal lung cancer screening programs. However, adoption rates remain largely low. This study aims to understand how lung cancer screening programs are currently performing. It also identifies the barriers and enablers contributing to adoption of lung cancer screening across 10 case study countries: Canada, China, Croatia, Japan, Poland, South Korea and the United States. Adoption rates vary significantly across studied countries. We find five main factors impacting adoption: (1) political prioritization of lung cancer (2) financial incentives/cost sharing and hidden ancillary costs (3) infrastructure to support provision of screening services (4) awareness around lung cancer screening and risk factors and (5) cultural views and stigma around lung cancer. Although these factors have application across the countries, the weighting of each factor on driving or hindering adoption varies by country. The five areas set out by this research should be factored into policy making and implementation to maximize effectiveness and outreach of lung cancer screening programs.
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Affiliation(s)
| | - Tim Wilsdon
- Charles River Associates, London, United Kingdom
| | - Iqra Sarwar
- Charles River Associates, London, United Kingdom
| | | | - Megan Yuan
- Merck & Co., Inc., Kenilworth, NJ, United States
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Mijiti Y, Yusupu H, Liu H, Zhang X, Maimaiti G, Kawuli R, Ma C. Survey on cervical cancer knowledge and its influencing factors among 2,578 women in Shache county, Kashi, China. BMC Womens Health 2023; 23:246. [PMID: 37161396 PMCID: PMC10170853 DOI: 10.1186/s12905-023-02390-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 04/23/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND In the southern part of Xinjiang, the incidence and mortality rates of the cervical cancer among Uyghurs are significantly higher than those of other ethnic groups living in the same environment, and their mortality rate takes the first place among ethnic minorities in China. OBJECTIVE To assess the level of cervical cancer knowledge by Questionnaire survey using the scoring system and its influencing factors among women in Shache county, Kashi, China. METHOD Based on the cervical cancer health education carried out by the medical team of the county hospital to the residents in the urban and rural areas of Shache County from September 1st, 2022, to September 30th, 2022, a cluster sampling was conducted at the same time and a total of 2578 women were included. The questionnaire survey includes resident basic information, and their knowledge about cervical cancer which was evaluated by the scoring system. The scoring system of the knowledge about cervical cancer includes 4 items, the total score was 8 point and scored more than 4 points was used as knowledge knowing, the knowledge of cervical cancer (unknown = 0; known = 1) was used as the dependent variable. Six factors include residence area (urban or rural), age, ethnic group, educational level, occupation, and the ways to acquire knowledge access were used as independent variables. The retrieved questionnaire was entered by the medical staff, and the Excel software was used for duplicate verification. Chi-square test and unconditional logistic regression analysis were used for statistical analysis. RESULTS Of the 2578 study subjects, 1591 were from rural areas and 987 were from the urban areas, and the differences were statistically significant (P < 0.001). Based on the scoring system of the knowledge about cervical cancer, the knowledge knowing accounts for only 34.1%. Multivariate logistic regression analysis showed that living in the urban(AOR = 1.358,95% CI:1.111-1.659), occupation of non-farming and non-housewife(AOR = 2.680,95%CI:2.126-3.377), education level of high school and above(AOR = 1.388,95%CI:1.125-1.712), and four or more access to knowledge(AOR = 1.446,95%CI:1.099-1.903) were protective factors for cervical cancer knowledge knowing. CONCLUSION Based on the questionnaire survey, the level of cervical cancer knowledge among women in Shache county was inadequate. Considering above mention influencing factors, it is necessary for the medical and health institutions to take various measures to carry out targeted health education on cervical knowledge for women in Shache county.
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Affiliation(s)
- Yilidana Mijiti
- Department of Gynecology, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Key Laboratory of Medical Animal Model Research, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
| | - Hainiguli Yusupu
- Department of Gynecology, Shache county people's hospital, Kashi, Xinjiang, P.R. China
| | - Haixia Liu
- Department of Gynecology, Shache county people's hospital, Kashi, Xinjiang, P.R. China
| | - Xuefeng Zhang
- Department of Gynecology, Shache county people's hospital, Kashi, Xinjiang, P.R. China
| | - Gulikezi Maimaiti
- Department of Gynecology, Shache county people's hospital, Kashi, Xinjiang, P.R. China
| | - Reyilaimu Kawuli
- Department of Gynecology, Shache county people's hospital, Kashi, Xinjiang, P.R. China
| | - Cailing Ma
- Department of Gynecology, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Key Laboratory of Medical Animal Model Research, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China.
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Mularczyk-Tomczewska P, Żarnowski A, Gujski M, Sytnik-Czetwertyński J, Pańkowski I, Smoliński R, Jankowski M. Preventive Health Screening during the COVID-19 Pandemic: A Cross-Sectional Survey among 102,928 Internet Users in Poland. J Clin Med 2022; 11:jcm11123423. [PMID: 35743493 PMCID: PMC9224829 DOI: 10.3390/jcm11123423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 01/27/2023] Open
Abstract
Preventive screening is a highly cost-effective public health intervention. The COVID-19 pandemic may impact preventive healthcare services. This study aimed to assess the frequency of preventive health screening, as well as to identify the factors associated with compliance with health screening guidelines among adults in Poland during the COVID-19 pandemic. This cross-sectional survey was carried out between October and December 2021, among Internet users in Poland. Respondents were asked about the last date that they performed seven different screening tests. Completed questionnaires were obtained from 102,928 adults aged 18−99 years, and 57.2% were female. The most common screening tests performed in the past 12 months were blood pressure measurement (83%), blood count (66.2%), and blood sugar (63.3%). Moreover, more than half of respondents had a urinalysis (53.1%) and lipid panel (55.1%) in the past 12 months. Out of 58,904 females, 69.2% had a cervical cytology in the past 3 years. Older age, having higher education, living in urban areas, being occupationally active, having at least one chronic disease, and visiting a doctor in the past 12 months were significantly associated (p < 0.001) with a higher level of compliance with screening guidelines. This study revealed a significant gap in the performance of preventive health screening.
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Affiliation(s)
| | - Adam Żarnowski
- Department of Public Health, Medical University of Warsaw, 02-097 Warsaw, Poland; (P.M.-T.); (A.Ż.)
| | - Mariusz Gujski
- Department of Public Health, Medical University of Warsaw, 02-097 Warsaw, Poland; (P.M.-T.); (A.Ż.)
- Correspondence:
| | | | - Igor Pańkowski
- Emergency Department, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, 02-004 Warsaw, Poland;
| | - Rafał Smoliński
- Niepubliczny Zespół Zakładów Opieki Zdrowotnej Wigor, 05-120 Legionowo, Poland;
| | - Mateusz Jankowski
- School of Public Health, Centre of Postgraduate Medical Education, 01-826 Warsaw, Poland; (J.S.-C.); (M.J.)
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Cervical Cancer Prevention in the Era of the COVID-19 Pandemic. Medicina (B Aires) 2022; 58:medicina58060732. [PMID: 35743995 PMCID: PMC9229337 DOI: 10.3390/medicina58060732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: Cervical cancer (CC) is the fourth most common cause of cancer-related morbidity and mortality among women worldwide. CC prevention is based on screening and HPV vaccination. The COVID-19 pandemic has caused difficulties in implementing CC-preventative measures. The aim of this study was to collect data on the implementation of CC prophylaxis in Poland provided by public and private health care with a particular focus on the impact of the COVID-19 pandemic and attempt to estimate the level of CC-screening implementation by 2026 under public and private health care. Materials and Methods: Data on the implementation of privately funded (2016–2021) and publicly funded (2014–2021) CC-preventative measures in Poland were examined. The Prophet algorithm, which positions itself as an automatic forecasting procedure and represents a local Bayesian structural time-series model, was used to predict data. The correlation test statistic was based on Pearson’s product moment correlation coefficient and follows a t distribution. An asymptotic confidence interval was given based on Fisher’s Z transform. Results: In 2021, a significantly higher population screening coverage was observed in private health care (71.91%) than in the public system (12.6%). Our estimation assumes that the adverse downward trend of population coverage (pap smear CC screening) in the public system will continue to 5.02% and in the private health system to 67.92% in 2026. Correlation analysis showed that with the increase in the sum of HPV tests and LBC, the percentage of Pap smear coverage in the private healthcare sector decreases r = −0.62, p = 0.260 df = 3, CI = [−0.97, 0.57]. The amount of HPV vaccinations provided in private health care is steadily increasing. Immunization coverage of the population of girls aged 9–18 years under private health care at the end of the observation period was 4.3% (2021). Conclusions: It is necessary to reorganize the public CC-screening system in Poland based on a uniform reporting system for tests performed in both public and private health care using the model of action proposed by us. We recommend the introduction of a national free HPV vaccination program funded by the government and implemented in public and private health care facilities.
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