Inequalities in access to cancer screening programmes in Spain and how to reduce them: data from 2013 and 2020
e202101017
Keywords:
Social inequalities, Equity, Cancer screeningAbstract
Background: The European Commission recommends ensuring equity in cancer screening. The aim of this study was to find out if there were inequalities in access to cancer screening programmes in Spain.
Methods: A transversal study was carried out by means of a survey addressed to the people responsible for breast, colorectal (CRC) and cervical cancer screening programmes in the 19 Autonomous Communities (AC) of Spain in 2013 and 2020. Information was collected on organizational characteristics, inequalities in access and interventions to reduce them. A descriptive analysis was made by AC and time period, by calculating frequencies and percentages, depending on the type of programme (breast, CRC and cervix).
Results: In 2013, 14 ACs participated for the breast programme, 8 for the CRC and 7 for the cervical programme; and in 2020, 14, 13 and 11 ACs respectively. All breast programmes were population-based in both periods (14/14 in 2013 and 14/14 in 2020), as well as CRC ones (8/8 in 2013 and 13/13 in 2020), with an increase in cervical cancer programmes (0/7 en 2013 y 6/11 en 2020). In both periods, social groups not included in the target population and groups that were less involved were identified, with differences according to the type of programme. A total of 53 interventions were carried out to reduce inequalities in access (27 in breast, 22 in RCC and 4 in cervical), 66% of them aimed at specific social groups (35/53).
Conclusions: Inequalities in access to cancer screening programmes in Spain are identified, as well as interventions to reduce them.
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References
Krieger N. Defining and investigating social disparities in cancer: critical issues. Cancer Cause Control. 2005;16:5-14. Review.
Holland W, Stewart S, Masseria C. Policy brief: screening in Europe. Geneva: World Health Organization, European Observatory on Health Systems and Policies; 2006.
Zengarini N, Ponti A, Tomatis M, Casella D, Giordano L, Mano MP et al. Absence of socioeconomic inequalities in access to good-quality breast cancer treatment within a population-wide screening programme in Turin (Italy). Eur J Cancer Prev. 2016;25:538-46.
Council of the European Union. Council Recommendation of 2 December 2003 on Cancer Screening (2003/878/EC). OJ, 2003; L327:34-38.
Ministerio de Sanidad, Servicios Sociales e Igualdad. Estrategia en Cáncer del Sistema Nacional de Salud. Actualización aprobada por el Consejo Interterritorial del Sistema Nacional de Salud, el 22 de octubre de 2009. Madrid; 2010. p. 169.
Orden SSI/2065/2014, de 31 de octubre, por la que se modifican los anexos I, II y III del Real Decreto 1030/2006, de 15 de septiembre, por el que se establece la cartera de servicios comunes del Sistema Nacional de Salud y el procedimiento para su actualización. Boletín Oficial del Estado, 6 de noviembre de 2014.
Ponencia de Cribado Poblacional de la Comisión de Salud Pública. Documento marco sobre cribado poblacional. Ministerio de Sanidad, Política Social e Igualdad. Madrid; 2010. Disponible en: https://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/Cribado/docs/Cribado_poblacional.pdf
Perry N, Broeders M, de Wolf C, Törnberg S, Holland R, von Karsa, editores. European guidelines for quality assurance in breast cancer screening and diagnosis, 4th ed, Supplements. Luxembourg, Office for Official Publications of the European Union; 2013.
Segnan N, Patnick J, von Karsa L, editores. European guidelines for quality assurance in colorectal cancer screening and diagnosis. Luxembourg, Office for Official Publications of the European Union; 2010.
Anttila A, Arbyn M, De Vuyst H, Dillner L, Franceschi S, Patnick J et al, editores. European guidelines for quality assurance in cervical cancer screening, 2nd ed, Supplements. Luxembourg, Office for Official Publications of the European Union; 2015.
Palència L, Espelt A, Rodríguez-Sanz M, Puigpinós R, Pons-Vigués M, Pasarín I. Socio-economic inequalities in breast and cervical cancer screening practices in Europe: influence of the type of screening program. Int J Epidemiol. 2010;39:757-65.
von Euler-Chelpin M, Olsen AH, Njor S, Vejborg I, Schwartz W, Lynge E. Socio-demographic determinants of participation in mammography screening. Int J Cancer. 2008;122:418-23.
Szczepura A, Price C, Gumber A. Breast and bowel cancer screening uptake patterns over 15 years for UK south Asian ethnic minority populations, corrected for differences in socio-demographic characteristics. BMC Public Health. 2008;8:346
Binefa G, García M, Peiró R, Molina-Barceló A, Ibáñez R; en nombre de los participantes del encuentro «¿Cómo reducir las desigualdades sociales en los programas de cribado de cáncer?». [How to assess and reduce social inequalities in cancer screening programmes]. Gac Sanit. 2016;30:232-4.
Red de Programas de Cribado de Cáncer. Disponible en http://www.cribadocancer.es/ [consultado el 23/09/2020]
Ministerio de Sanidad, Servicios Sociales e Igualdad. Guía metodológica para integrar la equidad en las estrategias, programas y actividades de salud. Madrid: Ministerio de Sanidad, Servicios Sociales e Igualdad; 2012.
Whitehead M, Dahlgren G. Levelling Up, Part 1: Concepts and principles for tackling social inequalities in health. Copenhagen: World Health Organization; 2006. P-2-4.
Hurtado JL, Bacigalupe A, Calvo M, Esnaola S, Mendizabal N, Portillo I et al. Social inequalities in a population based colorectal cancer screening programme in the Basque Country. BMC Public Health. 2015;15:1021.
Vanaclocha-Espi M, Ibáñez J, Molina-Barceló A, Pérez E, Nolasco A, Font R et al. Factors influencing participation in colorectal cancer screening programs in Spain. Prev Med. 2017;105:190-196.
Molina-Barceló A, Salas-Trejo D, Peiró-Pérez R, Vanaclocha M, Pérez E, Castán S. Reasons for participating in the Valencian Community Colorectal Cancer Screening Programme by gender, age, and social class. Rev Esp Enferm Dig. 2014;106:439-47.
García M, Borràs JM, Milà N, Espinàs JA, Binefa G, Fernández E et al. Factors associated with initial participation in a population-based screening for colorectal cancer in Catalonia, Spain: a mixed-methods study. Prev Med. 2011;52:265-7.
Ponti A, Anttila A, Ronco G, Senore C, Basu P, Segnan N et al. Cancer screening in the European Union. Final report on the implementation of the Council Recommendation on cancer screening. Luxembourg, Office for Official Publications of the European Union; 2017.
Benach J, Muntaner C. Aprender a mirar la salud: cómo la desigualdad social daña nuestra salud. Barcelona: El Viejo Topo; 2005.
Tudor Hart J. The inverse care law. Lancet. 1971:405–12, i.
Coq D, Asián R. Estudio de la “deseabilidad social” en una investigación mediante encuestas a empresarios andaluces. Metodología de Encuestas, 2002;4:211-225. ISSN:1575-7803
Frohlich KL, Potvin L. Transcending the known in public health practice: the inequality paradox: the population approach and vulnerable populations. Am J Public Health. 2008;98:216-21.
Hirth JM, Laz TH, Rahman M, Berenson AB. Racial/Ethnic Differences Affecting Adherence to Cancer Screening Guidelines Among Women. J Womens Health (Larchmt). 2016;25:371-80
Javanparast S, Ward P, Young G, Wilson C, Carter S, Misan G et al. How equitable are colorectal cancer screening programs which include FOBTs. A review of qualitative and quantitative studies. Prev Med. 2010;50:165–72.
Espinas JA, Aliste L, Fernández E, Argimon JM, Tresserras R, Borras JM. Narrowing the equity gap: the impact of organized vs opportunistic cancer screening in Catalonia (Spain). J Med Screen.2011;18:87-90
Giorgi Rossi P, Camilloni L, Cogo C, Federici A, Ferroni E, Furnari G et al. Metodi per aumentare la partecipazione ai programmi di screening oncologici [Methods to increase participation in cancer screening programmes]. Epidemiol Prev. 2012;36(1 Suppl 1):1-104.
Marmot M. Fair Society, Healthy Lives: The Marmot Review. London: Strategic Review of Health Inequalities in England post-2010; 2010.
Marmot M. Social determinants of health inequalities. Lancet. 2005;365:1099-104.
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Copyright (c) 2021 Ana Molina-Barceló, Julia Moreno Salas, Rosana Peiró-Pérez, Gerardo Arroyo, Josefa Ibáñez Cabanell, Mercedes Vanaclocha Espí, Gemma Binefa, Montse García, Dolores Salas Trejo, Red Española de Cribado, Grupo de Cribado de la Sociedad Española de Epidemiología (colaboración)
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