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Cancer is the second most common cause
of death in OECD countries, responsible for 28% of all deaths in 2009. Among women, breast
cancer is the most common form, accounting for 30% of new cases each year and 15% of
cancer deaths in 2009. Cervical cancer adds an additional 3% of new cases, and 2% of
female cancer deaths (see Indicator 1.4, "Mortality from
cancer" ).
The early detection of breast and
cervical cancers through screening programmes has contributed to increased survival rates,
and many countries have opted to make screening widely available. In most countries, more
than half of women in the target age groups have had a recent mammogram, and a pelvic exam
or Pap smear (see
).
Screening rates vary widely among
women in different socio-economic groups in OECD countries (Figure 6.7.1
and Figure 6.7.2). Even in those countries where the practice is
common, women in lowest income groups are generally less likely to undergo screening.
Income-related inequalities in cervical cancer screening are significant in 15 of the
16 countries studied. However, pro-rich inequalities in breast cancer screening are
significant in fewer countries (Belgium, Canada, Estonia, France, New Zealand, Poland and
the United States).
In the United States, low-income
women, women who are uninsured or receiving Medicaid (health insurance coverage for the
poor, disabled or impoverished elderly) or women with lower educational levels report much
lower use of mammography and Pap smears (NCHS, 2011). There is additional evidence in
European countries for significant social inequalities in utilisation of early detection
and prevention health care services (von Wagner et al.,
2011). In particular, women with higher level of assets are more likely to have mammograms
(Sirven and Or, 2010).
In Mexico, cervical cancer detection
programmes have been in place for some time, but problems with access and coverage remain,
especially among disadvantaged groups, so that almost half of women aged 50 years and over
have not had a Pap test in the last two years (Couture et al., 2008). In most OECD countries, however, income should not be a
barrier to accessing screening mammography or Pap smears, since the services are provided
free of charge, or at the cost of a doctor consultation.
Participation rates also vary by
geographic regions (Figure 6.7.3). Some areas, such as the
Northern Territory (Australia), and London (the United Kingdom), exhibit significantly
lower rates than do other regions within the country. The reasons for this are varied. In
geographically isolated regions such as the Northern Territory, travelling distance, the
availability of screening services and access barriers for Indigenous women play a part.
In inner urban areas of London, low levels of awareness of screening programmes, symptoms
and risks are a concern among women who are poor, or from minority ethnic groups.
A number of socio-economic
characteristics - such as income, ethnicity, younger age, higher level of education,
employment status, residential area, marital status, having health insurance, good health
status, having a usual source of care and use of other preventative services - are all
important predictors of participation in screening.
Since a wide range of screening
practices and different access barriers exist across OECD countries, no single strategy
will meet all needs in promoting greater and equal coverage (Gakidou et al., 2008). In countries with sufficient health system
capacity, increased screening can be encouraged by ensuring services are free, and are
available where needed. Policies and interventions may need to be better targeted in order
to overcome inequalities. As a complementary tool, the promise of new cancer preventing
vaccines also has important implications for resource-poor settings where maintaining
screening programmes is challenging.
Definition and comparability
Breast and cervical screening
participation rates measure the proportion of women of a given age who have variously
received a recent mammogram, breast exam, pap smear or pelvic exam. Information is
generally derived from health surveys, or from screening programme administrative
data.
Rates by income groups were
derived from health surveys. For cervical, women aged 20-69 years were asked whether
they had been screened in the three years prior to the survey, and for breast, women
aged 50-69 years in the past two years. The exception was Denmark (for breast only),
where screening was reported for the past 12 months. Screening estimates based on
self-reported health surveys should be used cautiously, since respondents tend to
overestimate desirable behaviours.
The data for geographic regions
include women in target age groups who had participated in national screening
programmes. Target age groups and screening periodicity may differ across
countries.
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| Indicator in PDF |
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| 6.7.1 Cervical cancer screening in past three years,
by income level, 2009 (or nearest year) |
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| 6.7.2 Breast cancer screening in past two years, by income
level, 2009 (or nearest year) |
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| 6.7.3 Participation in breast cancer screening programmes,
regions in selected OECD countries |
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