Effect of Pap-smear and sociodemographic factors on cervical cancer risk in Estonia: A population-based case-control study

Nõmm, Oskar; Veerus, Piret; Orumaa, Madleen; Innos, Kaire

doi:10.1016/j.canep.2022.102231

Cited by 6 publications

(6 citation statements)

References 16 publications

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“…Our finding that less than half of the women with a cervical cancer diagnosis had a cervical cytology 10 years prior to a cancer diagnosis is in line with a recently published case–control study 8 . Several studies in Estonia have been undertaken to better understand why women choose not to attend the clinic and give a non-invasive, painless free-of-charge test 21 , 22 .…”

Section: Discussionsupporting

confidence: 92%

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Cervical cancer screening history among women diagnosed with cervical cancer in Estonia 2017–18

Orumaa

Innos

Suurna

et al. 2022

European Journal of Public Health

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Background Despite the national cervical cancer screening programme launched in 2006, Estonia has one of the highest cervical cancer incidence rates in Europe. While the overall coverage of cervical cytology is high, the factors related to cancer screening history prior to cancer diagnosis need to be studied. Methods In this study, we aimed to examine the 10-year screening history of women diagnosed with cervical cancer in Estonia in 2017–18, using data collected from laboratory reports from 2007 to 2018. From each report, we extracted information on the date and result of cytology and on the laboratory where the sample was assessed. We analysed these data across cancer histology, the time interval between the last test result and cancer diagnosis and the laboratory type (local or regional). Results Among 319 women with cervical cancer, 181 (56.7%) did not have any cytology reports available. Among 138 women with at least one cytology, 60% had 1–3, 24% 4–6 and 16% ≥7 tests (mean 3.7) before cancer. In 78% of women, the last test was performed less than 5 years before cancer diagnosis and 62% of these tests did not report any abnormalities. The last cytology results differed significantly between the regional and local laboratories (P = 0.028). Conclusion Women received the cervical cancer diagnosis in Estonia despite having several screening tests 10 years prior to the diagnosis. The proportion of cytology tests without any abnormalities less than 5 years before the diagnosis was worryingly high and needs further investigation together with the difference between laboratory types.

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Section: Discussionsupporting

confidence: 92%

“…A recent case–control study showed that half of the Estonian women diagnosed with cervical cancer had not undertaken any cytology tests during a 7-year period before the diagnosis 8 . Still, another half of the women diagnosed with cervical cancer had been screened at least once.…”

Section: Introductionmentioning

confidence: 99%

Cervical cancer screening history among women diagnosed with cervical cancer in Estonia 2017–18

Orumaa

Innos

Suurna

et al. 2022

European Journal of Public Health

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“…Unemployed women were less likely to undergo a Pap smear test, consistent with findings from both a 2004 Estonian study [ 9 ] as well as studies from other countries [ 16 – 18 , 27 , 28 ]. Lack of health insurance seems to be the most obvious reason for this finding but according to our study, having health insurance was only associated with the lifetime uptake of Pap smear in univariate analysis and after adjusting to other variables this association disappeared.…”

Section: Discussionsupporting

confidence: 86%

“…Earlier Estonian studies have reported, consistent with the results of national and international studies, that lower education, unemployment, low physical activity, obesity, and smoking have an unfavourable effect on Pap smear uptake [ 9 – 11 ]. Previous Estonian studies investigating the factors related to screening attendance are, however, over 15 years old [ 10 , 11 ], or using registry data only [ 9 ], excluding valuable self-reported information. To increase CC screening attendance in Estonia it is necessary to improve the knowledge base on inequalities in Pap smear uptake.…”

Section: Introductionsupporting

confidence: 60%

“…A recent Estonian study found, that over half of the women with confirmed CC diagnosis did not have a Pap smear at least seven years before the disease, indicating the protective effect of having at least one Pap smear over the last seven years before the disease [ 9 ]. Earlier Estonian studies have reported, consistent with the results of national and international studies, that lower education, unemployment, low physical activity, obesity, and smoking have an unfavourable effect on Pap smear uptake [ 9 – 11 ]. Previous Estonian studies investigating the factors related to screening attendance are, however, over 15 years old [ 10 , 11 ], or using registry data only [ 9 ], excluding valuable self-reported information.…”

Section: Introductionmentioning

confidence: 99%

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Inequalities in reported use of cervical screening in Estonia: results from cross-sectional studies in 2004–2020

et al. 2022

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Background Despite the national cervical cancer (CC) screening program established in 2006, the CC incidence in Estonia in 2020 was still one of the highest in Europe. To better understand the possible barriers among women, the aim of this study was to describe the inequalities in the Pap smear uptake trend in 2004–2020 and to analyse the associations between different factors in Estonia. Methods Weighted data of 25–64-year-old women (N = 6685) from population-based cross-sectional studies of Health Behaviour among Estonian Adult Population in 2004–2020 was used. Linear trends in uptake of Pap smear over time were tested using the Cochrane-Armitage test. Binary logistic regression with interactions was performed to analyse associations between the uptake of Pap smear and sociodemographic, socioeconomic, health-related and lifestyle factors. Crude and adjusted odds ratios with 95% confidence intervals were calculated. Results Prevalence of lifetime uptake of Pap smear increased in 2004–2020 from 50.6 to 86.7% (P < 0.001). From 2004 to 2020, uptake of Pap smear increased significantly among women aged 25–34, 35–44, 45–54 and 55–64, in both ethnicity groups and among women with basic, secondary and higher education (P < 0.001). The gap in Pap smear uptake increased between Estonians and non-Estonians but decreased between education levels over time. Lower lifetime uptake of Pap smear was associated from sociodemographic factors with younger age, being non-Estonian and single, from socioeconomic factors with lower educational level and unemployment, from health indicators with higher body mass index indicating overweight and obesity, presence of chronic disease and depressiveness, and from lifestyle factors with non-smoking. Conclusions Although Pap smear uptake among 25–64 year old women increased significantly in Estonia in 2004–2020, inequalities were found indicating an opportunity for development of targeted CC prevention strategies.

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Factors associated with advanced-stage diagnosis of cervical cancer in Estonia: a population-based study

Šavrova,

Jaal,

Nõmm

et al. 2023

Public Health

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Effect of Pap-smear and sociodemographic factors on cervical cancer risk in Estonia: A population-based case-control study

Cited by 6 publications

References 16 publications

Cervical cancer screening history among women diagnosed with cervical cancer in Estonia 2017–18

Cervical cancer screening history among women diagnosed with cervical cancer in Estonia 2017–18

Inequalities in reported use of cervical screening in Estonia: results from cross-sectional studies in 2004–2020

Factors associated with advanced-stage diagnosis of cervical cancer in Estonia: a population-based study

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