Cervical cancer (over)screening in Belgium and Switzerland: trends and social inequalities

De Prez, Vincent; Jolidon, Vladimir; Willems, Barbara; Cullati, Stéphane; Burton-Jeangros, Claudine; Bracke, Piet

doi:10.1093/eurpub/ckaa041

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Journal article

Cervical cancer (over)screening in Belgium and Switzerland: trends and social inequalities

De Prez, Vincent Department of Sociology, Ghent University, Ghent, Belgium
Jolidon, Vladimir Institute of Sociological Research, Geneva School of Social Sciences, University of Geneva, Geneva, Switzerland
Willems, Barbara Department of Sociology, Ghent University, Ghent, Belgium
Cullati, Stéphane Institute of Sociological Research, Geneva School of Social Sciences, University of Geneva, Geneva, Switzerland - Population Health Laboratory, Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
Burton-Jeangros, Claudine Institute of Sociological Research, Geneva School of Social Sciences, University of Geneva, Geneva, Switzerland
Bracke, Piet Department of Sociology, Ghent University, Ghent, Belgium

01.06.2020

Published in:

European Journal of Public Health. - 2020, vol. 30, no. 3, p. 552–557

English Cervical cancer screening (CCS) by means of Pap smears has led to a decrease in cervical cancer incidence and mortality. In the absence of organized programmes, CCS is opportunistic in Belgium and Switzerland. This might result in a high level of CCS overuse, as screening practices do not conform to the recommended 3-yearly screening interval and the target age-ranges (Belgium: 25–64, Switzerland: 20–70). This study aimed to assess trends in CCS uptake and overuse in Belgium and Switzerland and their social determinants, in the light of reimbursement initiatives, which were implemented in both countries.Methods: Data from five waves of the Belgian Health Interview Survey (1997–2013) (N=11 141) and Swiss Health Interview Survey (1992–2012) (N=32 696) were used. We performed Poisson regressions to estimate adjusted prevalence ratios (APR), controlled for socio-economic and socio- demographic characteristics and health status. CCS overuse was operationalized as screening more than once every 3 years and screening above recommended age- range.Results: CCS uptake remained relatively stable over time, with a mean coverage of 70.9% in Belgium and 73.1% in Switzerland. Educational and income gradients were found in both countries. Concerning CCS overuse, women above screening-eligible age showed consistently high screening rates, but screening within the past year declined significantly in both countries, matching the temporal implementation of the reimbursement initiatives.ConclusionsAlthough no increase in CCS coverage could be established, CCS has become more efficient in both countries as Pap smear overuse at the population level has declined after the implementation of reimbursement measures tackling CCS overuse.

Faculty

Faculté des sciences et de médecine

Department

Master en médecine

Language