Organized screening programmes for breast and cervical cancer in 17 EU countries: trajectories of attendance rates

BackgroundThe aim was to analyse participation trajectories in organised breast and cervical cancer screening programmes and the association between socioeconomic variables and participation.MethodsA pooled, cross-sectional, time series analysis was used to evaluate secondary data from 17 European countries in 2004-2014.ResultsThe results show that the mammographic screening trend decreases after an initial increase (coefficient for the linear term=0.40; p=0.210; 95% CI=-0.25, 1.06; coefficient for the quadratic term=-0.07; p=0.027; 95% CI=-0.14, -0.01), while the cervical screening trend is essentially stable (coefficient for the linear term=0.39, p=0.312, 95% CI=-0.42, 1.20; coefficient for the quadratic term=0.02, p=0.689, 95% CI=-0.07, 0.10). There is a significant difference among the country-specific slopes for breast and cervical cancer screening (SD=16.7, p<0.001; SD=14.4, p<0.001, respectively). No association is found between participation rate and educational level, income, type of employment, unemployment and preventive expenditure. However, participation in cervical cancer screening is significantly associated with a higher proportion of younger women ( 49years) and a higher Gini index (that is, higher income inequality).ConclusionsIn conclusion three messages: organized cancer screening programmes may reduce the socioeconomic inequalities in younger people's use of preventive services over time; socioeconomic variables are not related to participation rates; these rates do not reach a level of stability in several countries. Therefore, without effective recruitment strategies and tailored organizations, screening participation may not achieve additional gains.