Low Coverage and Disparities of Breast and Cervical Cancer Screening in Thai Women: Analysis of National Representative Household Surveys

Abstract

Background: The coverage of breast and cervical cancer screening has only slightly increased in the past decade in Thailand, and these cancers remain leading causes of death among women. This study identified socioeconomic and contextual factors contributing to the variation in screening uptake and coverage. Materials and Methods: Secondary data from two nationally representative household surveys, the Health and Welfare Survey (HWS) 2007 and the Reproductive Health Survey (RHS) 2009 conducted by the National Statistical Office were used. The study samples comprised 26,951 women aged 30-59 in the 2009 RHS, and 14,619 women aged 35 years and older in the 2007 HWS were analyzed. Households of women were grouped into wealth quintiles, by asset index derived from Principal components analysis. Descriptive and logistic regression analyses were performed. Results: Screening rates for cervical and breast cancers increased between 2007 and 2009. Education and health insurance coverage including wealth were factors contributing to screening uptake. Lower or noneducated and poor women had lower uptake of screenings, as were young, unmarried, and non-Buddhist women. Coverage of the Civil Servant Medical Benefit Scheme increased the propensity of having both screenings, while the universal coverage scheme increased the probability of cervical screening among the poor. Lack of awareness and knowledge contributed to non-use of both screenings. Women were put off from screening, especially Muslim women on cervical screening, because of embarrassment, fear of pain and other reasons. Conclusions: Although cervical screening is covered by the benefit package of three main public health insurance schemes, free of charge to all eligible women, the low coverage of cervical screening should be addressed by increasing awareness and strengthening the supply side. As mammography was not cost effective and not covered by any scheme, awareness and practice of breast self examination and effective clinical breast examination are recommended. Removal of cultural barriers is essential.

Evaluation of the Relationship Between Family History of Breast Cancer and Risk Perception and Impacts on Repetition of Mammography

“…examination led to increased rate of mammography. It seems that, after the diagnosis of a problem in the clinical breast exam, women are recommend to do mammography (Tolma et al, 2011;Mukem et al, 2014). There are other factors that predict indirect relationship between risk perception and repetition of mammography.…”

Breast cancer early detection: A phased approach to implementation

“…The essential package funded in each country will depend on what is affordable. Governments may decide to offer subsidized care to a targeted population, or they may initially cover fewer interventions and increase them over time, as resource envelopes rise, as has been done in several LMICs, including Mexico 62 and Thailand 63,64 …”

National screening programs for cervical cancer in Asian countries

“…HPV vaccination was introduced in 2017, as a school-based National Immunization Program only for 5th grade girls, aged 11-12 years. Two national surveys reported that the coverage rates for cervical cancer screening were 46.3% and 59.7% in 2007 and 2009, respectively [37].…”