Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
Cancer Control Center, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka 541-8567, Japan.
Prev Med. 2021 Sep;150:106627. doi: 10.1016/j.ypmed.2021.106627. Epub 2021 May 18.
Finding effective strategies to increase participation in cervical cancer screening (CCS), breast cancer screening (BCS) and colorectal cancer screening (CRCS) for women is an important public health issue. Our objective was to examine combined patterns of participation in these three screenings and investigate the factors associated with non-participation in each. We analyzed 115,254 women aged 40-69 who were age-eligible for all three screenings from a 2016 nationally representative cross-sectional survey in Japan. Eight screening patterns were defined as full-participation (CCS + BCS + CRCS), partial-participation (CCS + BCS, CCS + CRCS, BCS + CRCS, CCS, BCS, CRCS), and non-participation (none). Multinomial logistic regression analysis adjusted for age, marital status, educational attainment, employment status, self-rated health, current hospital visits, and smoking status was performed to evaluate the factors associated with each screening pattern, using full-participation as the reference category. Screening rates for cervical, breast, and colorectal cancer were 45.0%, 46.2%, and 40.4%, respectively. Although only 26.9% of women participated in all three screenings, more than 60% participated in at least one screening. Unstable employment, low educational attainment, low self-rated health, and current smoker were associated with both non-participation and partial-participation, especially single-participation in cervical and breast cancer screening. For example, self-employed women were more likely to be non-participants [aOR 2.80 95%CI: 2.65-2.96], single-participants for CCS [aOR 2.87 95%CI: 2.57-3.20], and BCS [aOR 2.07 95%CI: 1.85-2.33] than permanent workers. It may be useful to consider related factors for non-participation patterns to encourage partial-participants to have other cancer screenings by utilizing one cancer screening as an opportunity to provide information about other screenings.
寻找提高女性宫颈癌筛查（CCS）、乳腺癌筛查（BCS）和结直肠癌筛查（CRCS）参与度的有效策略是一个重要的公共卫生问题。我们的目标是研究这三种筛查的联合参与模式，并调查与每种筛查不参与相关的因素。我们分析了 2016 年日本一项全国代表性横断面调查中年龄在 40-69 岁、符合所有三种筛查条件的 115254 名女性。根据完全参与（CCS+BCS+CRCS）、部分参与（CCS+BCS、CCS+CRCS、BCS+CRCS、CCS、BCS、CRCS）和不参与（无）这八种筛查模式，定义了八种筛查模式。使用完全参与作为参考类别，通过多变量逻辑回归分析调整年龄、婚姻状况、教育程度、就业状况、自我评估健康状况、当前医院就诊情况和吸烟状况，评估与每种筛查模式相关的因素。宫颈癌、乳腺癌和结直肠癌的筛查率分别为 45.0%、46.2%和 40.4%。尽管只有 26.9%的女性参加了所有三种筛查，但超过 60%的女性至少参加了一种筛查。不稳定的就业、低教育程度、低自我评估健康状况和当前吸烟者与不参与和部分参与均相关，尤其是单参与宫颈癌和乳腺癌筛查。例如，个体经营者更有可能不参与[OR 2.80 95%CI：2.65-2.96]、单参与 CCS [OR 2.87 95%CI：2.57-3.20]和 BCS [OR 2.07 95%CI：1.85-2.33]，而固定工人。考虑不参与模式的相关因素，利用一种癌症筛查作为提供其他筛查信息的机会，鼓励部分参与者进行其他癌症筛查，可能会有所帮助。
