Socioeconomic disparity in cervical cancer screening among Korean women: 1998–2010

Abstract

Background: Cervical cancer is the sixth most common cause of cancer among Korean women and is one of the most preventable cancers in the world. This study aimed to investigate the change in cervical cancer screening rates, the level of socioeconomic disparities in cervical cancer screening participation, and whether there was a reduction in these disparities between 1998 and 2010. Methods: Using the Korean Health and Nutrition Examination Survey, women 30 years or older without a history of cervical cancer and who completed a health questionnaire, physical examination, and nutritional survey were included (n = 17,105). Information about participation in cervical cancer screening was collected using a self-administered questionnaire. Multiple logistic regression analysis was performed to investigate the relationship between cervical cancer screening participation and the socioeconomic status of the women. Results: The cervical cancer screening rate increased from 40.5% in 1998 to 52.5% in 2010. Socioeconomic disparities influenced participation, and women with lower educational levels and lower household income were less likely to be screened. Compared with the lowest educational level, the adjusted odds ratios (ORs) for screening in women with the highest educational level were 1.56 (95% confidence interval (CI): 1.05-2.30) in 1998, and 1.44 (95% CI: 1.12-1.87) in 2010. Compared with women with the lowest household income level, the adjusted ORs for screening in women with the highest household income level were 1.80 (95% CI: 1.22-2.68), 2.82 (95% CI: 2.01-3.96), and 1.45 (95% CI: 1.08-1.94) in 2001, 2005, and 2010, respectively. Conclusion: Although population-wide progress has been made in participation in cervical cancer screening over the 12-year period, socioeconomic status remained an important factor in reducing compliance with cancer screening.

Examining the Cervical Screening Behaviour of Women Aged 50 or above and Its Predicting Factors: A Population-Based Survey

“…In the present study, fewer than half of Chinese older women had ever had a test, a lower rate than those reported by the comparable age group in other populations [16,17,19,20,21]. The majority of these women (65%) perceived their own low susceptibility to cancer, and 30% were unsure about their risk.…”

The prevalence and factors associated with cervical cancer screening among women in the general population: Evidence from National Health Survey

“…In contrast, women of lower socioeconomic status and education, unemployed and disabled women, and women who do not have a habit of visiting a gynecologist regularly are less likely to enter a screening program [25]. Some previous studies in the field have shown that household income is a significant predictor of cervical cancer screening practices and habits [26]. The current findings from Latin America show that the knowledge about the Pap smears and their importance in cancer prevention increases with age (reaching a plateau in the age group 31-35 years) and with education levels.…”

“…The current literature suggests that participation in cervical screenings of those individuals with lower income can be enhanced with adequate interventions at the primary health care level, where an additional focus should be placed on the members of vulnerable groups. Therefore, it is important to keep monitoring how the current public health policies, like expanding the scope of free cervical cancer examination of women whose households are in the lower 50% of the income bracket, impact the participation rates over time [26].…”

Cervical cancer still presents symptomatically 20 years after the introduction of a structured national screening programme

“…showed that insurance status is an independent predictor for poorer survival outcome, as it is related to late‐stage presentation and under‐treatment in the USA. Low socio‐economic and educational status are important factors, as compliance with cancer screening is significantly lower in this population, even in the UK, where screening is free to all irrespective of insurance status . Reasons for non‐compliance when access and finance are not an issue could be a lack of understanding of the natural history of cervical cancer and the role of screening, or because patient focus is more on prominent daily life issues and concerns rather than attending smear test invitations.…”

“…Low socio-economic and educational status are important factors, as compliance with cancer screening is significantly lower in this population, even in the UK, where screening is free to all irrespective of insurance status. 22,23 Reasons for non-compliance when access and finance are not an issue could be a lack of understanding of the natural history of cervical cancer and the role of screening, or because patient focus is more on prominent daily life issues and concerns rather than attending smear test invitations. Practical barriers were raised more often by younger women, whereas older women had more negative attitudes to screening.…”