Inequalities in adherence to cervical cancer screening in Portugal

Abstract

Cervical cancer is the second cancer with the highest incidence and mortality in women aged 15–44 living in Europe. Screening is an effective strategy to reduce these rates, although in Portugal, as in other European countries, adherence to screening still presents significant disparities. Thus, this study aimed to assess the prevalence and factors associated with cervical cancer screening (CCS) nonadherence in Portugal. Cross-sectional data from 5929 women aged 25–64 included in the 2014 Portuguese National Health Survey (2014 NHS) were analyzed. The prevalence of CCS nonadherence was estimated. The association between multiple factors and CCS nonadherence was analyzed, using logistic regression, adjusting for age and educational level. The weighted prevalence of nonadherence was 13.2% [95% confidence interval (CI): 12.0–14.0]. Additionally, 10.5% of women had performed the last cervical cytology 3 years ago or more. Higher odds of nonadherence to screening were found for younger women, with low levels of education and income, unemployed, single, born outside Portugal, who never had a medical appointment or had over 12 months ago, who were never pregnant and who had never had a mammography. No association was found with other variables studied, including having public/private health insurance, BMI or smoking status. This study showed that inequalities in CCS adherence in Portugal persist. These findings reinforce the need for developing strategies to reduce inequalities in CCS adherence.

Understanding Cervical Cancer Screening Barriers among Migrant Women: A Qualitative Study with Healthcare and Community Workers in Portugal

“…Participants agreed that migrant women have a lower participation in CCS comparing to non-migrant women, confirming other studies [ 18 , 22 , 23 , 24 ]. Previous experiences with preventive healthcare may increase CCS participation [ 11 , 20 , 25 ].…”

“…There are several examples of CCS programs in other countries, such as the United Kingdom, Finland, and the Netherlands, where population-based CCS programs are implemented nationwide, women are invited regularly for screening, and the programs are intensely disseminated through the population [ 16 , 17 ]. Data from the Portuguese National Health Survey, in 2014, indicate that migrant women have a lower participation in CCS than women born in Portugal [ 18 ].…”

Socio-economic inequality of utilization of cancer testing in Europe: A cross-sectional study

“…Although detection and treatment of cancer have improved considerably in recent decades, the death rate remains high ( Ferlay et al, 2018 ). Moreover, the cancer burden is unequally distributed within and among countries, with differences in risk, uptake of screening, and access to treatment ( Aarts et al, 2012 , Deandrea et al, 2010 , Palencia et al, 2010 , Puliti et al, 2012 , Cardoso et al, 2020 , Mahumud et al, 2020 , Nunes et al, 2021 , Pallesen et al, 2021 ). These differences all are associated with socioeconomic position.…”

Reducing Sexual and Reproductive Health Inequities Between Natives and Migrants: A Delphi Consensus for Sustainable Cross-Cultural Healthcare Pathways

“…Within the Gender and socioeconomic inequalities sub-dimension, the highest endorsement was found in the items “ Rate of adherence to cervical cancer screening” and “ Paternity leave utilization rate.” Strategies to reduce inequalities in adherence to cervical cancer screening are needed, to allow timely diagnosis and improve the sexual life of all women diagnosed after treatment. These include cultural competence in healthcare and having cervical cancer screening information linguistically and culturally adapted ( 124 , 125 ). Within the scope of the National Program for Oncological Diseases of the Portuguese General Directorate of Health, data on the rate of adherence to cervical cancer screening were released.…”