Department of Sociology, Ghent University, Belgium.
Institute of Sociological Research, Geneva School of Social Sciences, University of Geneva, Switzerland.
Scand J Public Health. 2023 Dec;51(8):1239-1247. doi: 10.1177/14034948221118215. Epub 2022 Aug 25.
Cervical cancer (CC) over-screening has been understudied in Europe, yet is relevant for approaching inequalities in screening uptake. Focusing on countries' screening strategies (opportunistic systems versus organised programmes), we assess in which contexts CC over-screening is more prevalent, and which women are more likely to have engaged in cervical cancer screening (CCS) within the past year.
A two-level (multilevel) design among screening women ( = 80,761) nested in 31 European countries was used to analyse data from the second wave (2013-2015) of the European Health Interview Survey. We focused on over-screening, defined as screening more frequently than the three-yearly screening interval prescribed in the European guidelines - that is, having screened within the past year.
Higher levels of over-screening were observed in opportunistic systems compared to systems with organised programmes. In opportunistic systems, women with a higher socioeconomic position had a higher likelihood of being screened within the past year than their socioeconomic counterparts. Moreover, these differences diminished under organised programmes.
Contexts with organised CCS programmes are more efficiently reducing over-screening, and enforcing the European guidelines. We suggest that the physician-patient relationship is an essential pathway for explaining socioeconomic differences in CC (over-)screening and for future interventions.
在欧洲，对宫颈癌过度筛查的研究较少，但这与解决筛查参与率不平等问题有关。本研究聚焦于各国的筛查策略（机会性筛查系统与组织性筛查项目），旨在评估哪些情况下宫颈癌过度筛查更为普遍，以及哪些女性更有可能在过去一年接受过宫颈癌筛查（CCS）。
采用嵌套于 31 个欧洲国家的筛查女性（=80761 人）的两水平（多水平）设计，对 2013-2015 年欧洲健康访谈调查第二波数据进行分析。我们重点关注过度筛查，即筛查频率高于欧洲指南规定的每三年一次的筛查间隔，也就是在过去一年进行过筛查。
与组织性筛查项目相比，机会性筛查系统中观察到更高水平的过度筛查。在机会性筛查系统中，社会经济地位较高的女性比其社会经济地位较低的女性更有可能在过去一年接受过筛查。此外，在组织性筛查项目中，这些差异有所缩小。
组织性 CCS 项目的实施背景下，过度筛查的情况有所减少，且更能有效地遵循欧洲指南。我们认为，医患关系是解释宫颈癌（过度）筛查中社会经济差异的一个重要途径，也是未来干预的一个切入点。
