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

Abstract

Background 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. Conclusions Although 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.

Never and under cervical cancer screening in Switzerland and Belgium: trends and inequalities

“…Living in rural area increased both never and under screening prevalence in Switzerland, while such inequalities were not found in Belgium. This is consistent with studies of other cancer screening tests in Switzerland [ 33 ] which pointed out that women living in a rural area might under-screen while their urban counterparts are more likely to over-screen [ 34 , 35 ].…”

“…Studies showed that opportunistic screening entailed higher screening inequalities, inconsistent quality and inefficiencies such as over-screening [ 8 , 36 – 38 ]. As a Swiss-Belgian comparative study on screening overuse showed, although declining, over-screening is persistent in both countries [ 35 ]. An organised approach to CCS, with quality assurance framework and strategies to improve never and under-screeners’ participation, may minimise the adverse effects of unequal screening and maximise benefits from a public health and cost perspective [ 37 , 39 ].…”

The Impact of the COVID-19 Pandemic and the Associated Belgian Governmental Measures on Cancer Screening, Surgical Pathology and Cytopathology

“…A third Belgian (pre)cancer screening programme consists of triannual cervical smears for women aged 25–64 [ 27 ]. Both cervical and non-gynaecological cytology rates dramatically collapsed during the HEP.…”

Macro-contextual determinants of cancer screening participation and inequalities: A multilevel analysis of 29 European countries

“…GP gatekeeping and stronger primary care (PC) systems, both decommodifying features, were associated with reduced screening uptake in opposition to our hypothesis. This could be explained by the prevailing overscreening in Pap smear uptake ( De Prez et al, 2020 ), particularly in opportunistic screening contexts, which is often due to gynaecologists performing Pap smear as part of routine check-ups on a yearly basis. In this regard, gatekeeping and stronger PC systems may act as regulatory mechanisms, controlling and containing the specialist visits and possibly limiting unnecessary screening.…”