Contextual factors associated with cancer screening uptake: A systematic review of observational studies

We conducted a systematic review of a wide range of contextual factors related to cancer screening uptake that have been studied so far. Studies were identified through PubMed and Web of Science databases. An operational definition of context was proposed, considering as contextual factors: social relations directly aimed at cancer screening, health care provider and facility characteristics, geographical/accessibility measures and aggregated measures at supra-individual level. We included 70 publications on breast, cervical and/or colorectal cancer screening from 42 countries, covering a data period of 24 years. A wide diversity of factors has been investigated in the literature so far. While several of them, as well as many interactions, were robustly associated with screening uptake (family, friends or provider recommendation, provider sex and experience, area-based socio-economic status…), others showed less consistency (ethnicity, urbanicity, travel time, healthcare density …). Screening inequities were not fully explained through adjustment for individual and contextual factors. Context, in its diversity, influences individual screening uptake and lots of contextual inequities in screening are commonly shared worldwide. However, there is a lack of frameworks, standards and definitions that are needed to better understand what context is, how it could modify individual behaviour and the ways of measuring and modifying it.

[Knowledge and attitudes of medical students at the end of their curriculum, towards breast and cervical cancer screening]

This study assesses knowledge and attitudes of medical students of the faculty of medicine of Tunis, at the end of their medical curriculum, towards breast and cervical cancer screening. Among the 644 medical students at the end of their curriculum, 592 answered to anonymous questionnaire (response rate = 92%). Results show that 34.1% have proposed systematic cervical cancer screening. This proportion was 61.0% for clinical breast cancer examination. The majority of students (70.2%) proposed to start this cervical screening since the first sexual activities. As for the periodicity of this screening, 44.2% are favourable for a yearly periodicity, 39.2% for every three years, 7.2% for every five years and 9.4% for a periodicity at least once in life. 94.1% of students declared to have learned clinical breast examination, contrarily to pap smear, for which this proportion was only 55.1%. Breast and cervical cancer control training, in the faculty of medicine of Tunis, is insufficient and should be improved and restructured.