Socioeconomic Disparity Trends in Cancer Screening Among Women After Introduction of National Quality Indicators

Abstract

PURPOSE Primary care physicians have an important role in encouraging adequate cancer screening. Disparities in cancer screening by socioeconomic status (SES) may affect presentation stage and cancer survival. This study aimed to examine whether breast, colorectal, and cervical cancer screening rates in women differed by SES and age, and whether screening rates and SES disparities changed after introduction of a primary care-based national quality indicator program. METHODS This repeated cross-sectional study spanning 2002-2017 included all female Israeli residents in age ranges appropriate for each cancer screening assessed. SES was measured both as an individual-level variable based on exemption from copayments and as an area-level variable using census data. RESULTSIn 2017, the most recent year in the study period, screening rates among 1,529,233 women were highest for breast cancer (70.5%), followed by colorectal cancer (64.3%) and cervical cancer (49.6%). Women in the highest area-level SES were more likely to undergo cervical cancer screening compared with those in the lowest (odds ratio = 3.56; 99.9% CI, 3.47-3.65). Temporal trends showed that after introduction of quality indicators for breast and colorectal cancer screening in 2004 and 2005, respectively, rates of screening for these cancers increased, with greater reductions in disparities for the former. The quality indicator for cervical cancer screening was introduced in 2015, and no substantial changes have occurred yet for this screening. CONCLUSIONSWe found increased uptake and reduced socioeconomic disparities after introduction of cancer screening indicators. Recent introduction of a cervical cancer screening indicator may increase participation and reduce disparities, as has occurred for breast and colorectal cancer screening. These findings related to Israel's quality indicators program highlight the importance of primary care clinicians in increasing cancer screening rates to improve outcomes and reduce disparities.

Epidemiological, Clinical, and Pathological Characteristics of Invasive Breast Cancer in Bedouin and Jewish Women in southern Israel: A Retrospective Comparative Study

“…The possible differences between the past study and ours, in the context of OS and DFS, could be explained by the improvement in primary, secondary, and tertiary prevention of IBC [9,33,34]. Over the past decade, primary prevention efforts to raise awareness about the importance of Oncologic, and particularly IBC, screening have been successful in the Israeli population by implementing multilingual educational campaigns via television, newsletters, and other media outlets in Hebrew, Arab, Russian, English, and French languages [14,35]. Moreover, a report published by the Israel Center for Disease Control, in 2008 described 51 women's and primary care clinics in the Bedouin community, which comprised at the time of approximately 184,000 residents [36,37].…”

“…Since prior studies assessed similar cancer characteristics among the Jewish and Bedouin population [1,10], we aimed to assess the most current data available on the epidemiology of IBC among Jewish and Bedouin women treated at Soroka medical center. We hypothesized that due to the signi cant investments of healthcare funds in the southern of Israel [14,15] and the transition of the Bedouin population to a more urbanized lifestyle [16], the prognosis of IBC among Bedouin women would be better than described in the past [1].…”

“…It aimed to increase adherence among women living in geographically and socially peripheral areas. Due to increased demand, another mobile unit was funded in 2011, making mammography examinations more accessible, causing a steady increase in compliance rates for IBC screenings among Bedouin women[14]. Previous works have shown that early treatment is crucial for improving the survival rate of breast cancer patients[38].…”

Data From a One-Stop-Shop Comprehensive Cancer Screening Center

“…This is not unique to Israel, and reducing the number of required visits for screening may make it more equitable. 15,16 The screening at the ICPC is not necessarily superior in quality, although having specialists conduct screening tests specific to their field could provide more quality and accuracy to the test. In addition, of importance is that results and further workup are expedited; many additional laboratory and NOTE.…”

Test performance metrics for breast, cervical, colon, and lung cancer screening: a systematic review

“…Quality metrics for cancer screening tests provide several opportunities: aspirational targets for individual programs, feedback to providers performing tests, criteria for competency and certification, and comparisons between different settings. Comparing quality metrics among population subgroups can reveal variation in screening effectiveness, including racial disparities ( 6 ). Useful quality metrics should provide valid and reliable measurements, be associated with meaningful outcomes, be feasible to implement, and at least partially explain unwarranted variations in clinical outcomes ( 7 ).…”