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Inequalities in reported use of breast and cervical screening in Great Britain: analysis of cross sectional survey data.

Moser K, Patnick J, Beral V - BMJ (2009)

Bottom Line: For cervical screening, ethnicity was the most important predictor; white British women were significantly more likely to have had a cervical smear than were women of other ethnicity (odds ratio 2.20, 1.41 to 3.42).Some inequalities exist in the reported use of screening, which differ by screening type; indicators of wealth were important for breast screening and ethnicity for cervical screening.The routine collection within general practice of additional sociodemographic information would aid monitoring of inequalities in screening coverage and inform policies to correct them.

View Article: PubMed Central - PubMed

Affiliation: Cancer Epidemiology Unit, University of Oxford, Oxford OX3 7LF. kath.moser@ceu.ox.ac.uk

ABSTRACT

Objective: To investigate the relation between women's reported use of breast and cervical screening and sociodemographic characteristics.

Design: Cross sectional multipurpose survey.

Setting: Private households, Great Britain. Population 3185 women aged 40-74 interviewed in the National Statistics Omnibus Survey 2005-7.

Main outcome measures: Ever had a mammogram, ever had a cervical smear, and, for each, timing of most recent screen.

Results: 91% (95% confidence interval 90% to 92%) of women aged 40-74 years reported ever having had a cervical smear, and 93% (92% to 94%) of those aged 53-74 years reported ever having had a mammogram; 3% (2% to 4%) of women aged 53-74 years had never had either breast or cervical screening. Women were significantly more likely to have had a mammogram if they lived in households with cars (compared with no car: one car, odds ratio 1.67, 95% confidence interval 1.06 to 2.62; two or more cars, odds ratio 2.65, 1.34 to 5.26), and in owner occupied housing (compared with rented housing: own with mortgage, odds ratio 2.12, 1.12 to 4.00; own outright, odds ratio 2.19, 1.39 to 3.43), but no significant differences by ethnicity, education, occupation, or region were found. For cervical screening, ethnicity was the most important predictor; white British women were significantly more likely to have had a cervical smear than were women of other ethnicity (odds ratio 2.20, 1.41 to 3.42). Uptake of cervical screening was greater among more educated women but was not significantly associated with cars, housing tenure, or region.

Conclusions: Most (84%) eligible women report having had both breast and cervical screening, but 3% report never having had either. Some inequalities exist in the reported use of screening, which differ by screening type; indicators of wealth were important for breast screening and ethnicity for cervical screening. The routine collection within general practice of additional sociodemographic information would aid monitoring of inequalities in screening coverage and inform policies to correct them.

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Fig 3 Percentage of women screened in most recent time period, comparing Omnibus Survey estimates with routine statistics. *Less than five years since last adequate test (women with recall ceased for clinical reasons excluded from denominator). †Less than five years since last test (women who have had hysterectomy excluded from denominator). ‡Less than three years since last test
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fig3: Fig 3 Percentage of women screened in most recent time period, comparing Omnibus Survey estimates with routine statistics. *Less than five years since last adequate test (women with recall ceased for clinical reasons excluded from denominator). †Less than five years since last test (women who have had hysterectomy excluded from denominator). ‡Less than three years since last test

Mentions: Although the lower cervical screening rate seen in our data among older women could result from under-reporting of events in the more distant past, it is plausible that the rates are in fact low in this age group. Women aged 65-74 in 2005 would have been in their 50s (that is, past reproductive ages and therefore less likely to have opportunistic smears) in 1990 when the screening programme became more comprehensive. Our estimates of the proportion of women who had had a cervical smear in the previous five years match quite closely the routine coverage statistics for 2006/7,6 although they are slightly lower for all age groups except women aged 70-74, for whom our figures indicate a higher percentage having had a smear in the previous five years (fig 3). With the exception of the oldest women, these differences could be due to the high proportion of women in our data who did not know the date of their most recent cervical smear and a tendency for women to under-report having had cervical screening. Our data and the routine statistics on women having a mammogram in the previous three years also agree quite closely.5 These comparisons with the routine statistics provide encouraging validation of the Omnibus Survey data.


Inequalities in reported use of breast and cervical screening in Great Britain: analysis of cross sectional survey data.

Moser K, Patnick J, Beral V - BMJ (2009)

Fig 3 Percentage of women screened in most recent time period, comparing Omnibus Survey estimates with routine statistics. *Less than five years since last adequate test (women with recall ceased for clinical reasons excluded from denominator). †Less than five years since last test (women who have had hysterectomy excluded from denominator). ‡Less than three years since last test
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2697310&req=5

fig3: Fig 3 Percentage of women screened in most recent time period, comparing Omnibus Survey estimates with routine statistics. *Less than five years since last adequate test (women with recall ceased for clinical reasons excluded from denominator). †Less than five years since last test (women who have had hysterectomy excluded from denominator). ‡Less than three years since last test
Mentions: Although the lower cervical screening rate seen in our data among older women could result from under-reporting of events in the more distant past, it is plausible that the rates are in fact low in this age group. Women aged 65-74 in 2005 would have been in their 50s (that is, past reproductive ages and therefore less likely to have opportunistic smears) in 1990 when the screening programme became more comprehensive. Our estimates of the proportion of women who had had a cervical smear in the previous five years match quite closely the routine coverage statistics for 2006/7,6 although they are slightly lower for all age groups except women aged 70-74, for whom our figures indicate a higher percentage having had a smear in the previous five years (fig 3). With the exception of the oldest women, these differences could be due to the high proportion of women in our data who did not know the date of their most recent cervical smear and a tendency for women to under-report having had cervical screening. Our data and the routine statistics on women having a mammogram in the previous three years also agree quite closely.5 These comparisons with the routine statistics provide encouraging validation of the Omnibus Survey data.

Bottom Line: For cervical screening, ethnicity was the most important predictor; white British women were significantly more likely to have had a cervical smear than were women of other ethnicity (odds ratio 2.20, 1.41 to 3.42).Some inequalities exist in the reported use of screening, which differ by screening type; indicators of wealth were important for breast screening and ethnicity for cervical screening.The routine collection within general practice of additional sociodemographic information would aid monitoring of inequalities in screening coverage and inform policies to correct them.

View Article: PubMed Central - PubMed

Affiliation: Cancer Epidemiology Unit, University of Oxford, Oxford OX3 7LF. kath.moser@ceu.ox.ac.uk

ABSTRACT

Objective: To investigate the relation between women's reported use of breast and cervical screening and sociodemographic characteristics.

Design: Cross sectional multipurpose survey.

Setting: Private households, Great Britain. Population 3185 women aged 40-74 interviewed in the National Statistics Omnibus Survey 2005-7.

Main outcome measures: Ever had a mammogram, ever had a cervical smear, and, for each, timing of most recent screen.

Results: 91% (95% confidence interval 90% to 92%) of women aged 40-74 years reported ever having had a cervical smear, and 93% (92% to 94%) of those aged 53-74 years reported ever having had a mammogram; 3% (2% to 4%) of women aged 53-74 years had never had either breast or cervical screening. Women were significantly more likely to have had a mammogram if they lived in households with cars (compared with no car: one car, odds ratio 1.67, 95% confidence interval 1.06 to 2.62; two or more cars, odds ratio 2.65, 1.34 to 5.26), and in owner occupied housing (compared with rented housing: own with mortgage, odds ratio 2.12, 1.12 to 4.00; own outright, odds ratio 2.19, 1.39 to 3.43), but no significant differences by ethnicity, education, occupation, or region were found. For cervical screening, ethnicity was the most important predictor; white British women were significantly more likely to have had a cervical smear than were women of other ethnicity (odds ratio 2.20, 1.41 to 3.42). Uptake of cervical screening was greater among more educated women but was not significantly associated with cars, housing tenure, or region.

Conclusions: Most (84%) eligible women report having had both breast and cervical screening, but 3% report never having had either. Some inequalities exist in the reported use of screening, which differ by screening type; indicators of wealth were important for breast screening and ethnicity for cervical screening. The routine collection within general practice of additional sociodemographic information would aid monitoring of inequalities in screening coverage and inform policies to correct them.

Show MeSH
Related in: MedlinePlus