Organized screening programmes for breast and cervical cancer in 17 EU countries: trajectories of attendance rates

摘要

The aim was to analyse participation trajectories in organised breast and cervical cancer screening programmes and the association between socioeconomic variables and participation. A pooled, cross-sectional, time series analysis was used to evaluate secondary data from 17 European countries in 2004-2014. The results show that the mammographic screening trend decreases after an initial increase (coefficient for the linear term?=?0.40; p?=?0.210; 95% CI?=?-?0.25, 1.06; coefficient for the quadratic term?=?-?0.07; p?=?0.027; 95% CI?=?-?0.14, -?0.01), while the cervical screening trend is essentially stable (coefficient for the linear term?=?0.39, p?=?0.312, 95% CI?=?-?0.42, 1.20; coefficient for the quadratic term?=?0.02, p?=?0.689, 95% CI?=?-?0.07, 0.10). There is a significant difference among the country-specific slopes for breast and cervical cancer screening (SD?=?16.7, p??0.001; SD?=?14.4, p??0.001, respectively). No association is found between participation rate and educational level, income, type of employment, unemployment and preventive expenditure. However, participation in cervical cancer screening is significantly associated with a higher proportion of younger women (≤ 49?years) and a higher Gini index (that is, higher income inequality). In conclusion three messages: organized cancer screening programmes may reduce the socioeconomic inequalities in younger people's use of preventive services over time; socioeconomic variables are not related to participation rates; these rates do not reach a level of stability in several countries. Therefore, without effective recruitment strategies and tailored organizations, screening participation may not achieve additional gains.