Personal and provider level factors influence participation to cervical cancer screening: A retrospective register-based study of 1.3 million women in Norway

Abstract

High coverage is essential for an effective screening programme. Here we present screening barriers and facilitators among 1.3 million women aged 25-69years eligible for screening within the Norwegian Cervical Cancer Screening Program (NCCSP). We defined non-adherence as no screening test in 2008-2012. We divided adherent women into those screened spontaneously, and those who had a smear after receiving a reminder from the NCCSP. Explanatory variables were extracted from several nationwide registers, and modelled by modified Poisson regression. In total, 34% of women were non-adherent. 31% of native Norwegians were non-adherent, compared to 50% of immigrants. Immigrant status was a strong predictor of non-adherence, but the vast majority of non-adherent women were still native Norwegians. Higher non-adherence rates were associated with having a male general practitioner (GP), a foreign GP, a young GP, and distance to the screening site. Being unmarried, having no children, having lower socioeconomic position and region of residence predicted non-adherence and, to a smaller extent, reminded adherence to screening. In contrast, previous experience with cervical abnormalities substantially increased adherence to screening. The population-based screening programme promotes equity by recruiting women who are less likely to participate spontaneously. However, socioeconomic disparities were evident in a country with a nationwide programme and a policy of equal access to health care. Initiatives aimed at removing practical and financial barriers to equitable screening delivery and at reducing the effect of sociodemographic attributes on screening participation are needed.

Barriers to cervical cancer screening: A qualitative study among Somali women in Oslo Norway

“…The women are advised to make appointment with their general practitioner for cervical cancer screening. A retrospective register-based study of 1.3 million women in Norway showed that 50% of immigrant women were non-adherent compared to 31% of native Norwegians [8]. Nonetheless, statistics about the burden of cervical cancer among immigrant women in Norway are lacking.…”

Incidence, mortality and risk factors of cervical cancer in the world

“…The results of several studies suggest that socioeconomic differences play an important role in the incidence, mortality and survival rate of cervical cancer (Akinyemiju et al, 2016;Ibfelt et al, 2013;Kim and Kang, 2016;Ueda et al, 2006). This is associated with a variety of factors, such as low access to screening (Leinonen et al, 2017), non-implementation of prevention programs (Chidyaonga-Maseko et al, 2015), ineffective and inadequate treatment, and poor sanitary conditions (Benard et al, 2008;Ganesan et al, 2015;Rossi et al, 2014).…”

Differences in cancer survival between immigrants in Norway and the host population

“…6 A previous study, investigating cancer stage distribution in immigrants compared to the Norwegian host population, showed that non-Western women had higher risk of being diagnosed with a more advanced stage of breast cancer. 8,9 The low screening attendance and advanced breast cancer stage distribution reported for non-Western immigrants may contribute to poor cancer survival. 8,9 The low screening attendance and advanced breast cancer stage distribution reported for non-Western immigrants may contribute to poor cancer survival.…”

“…7 Non-Western immigrants have also been shown to have lower attendance rate to both cervical and mammography screening. 8,9 The low screening attendance and advanced breast cancer stage distribution reported for non-Western immigrants may contribute to poor cancer survival.…”