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Cervical cancer (over)screening in Belgium and Switzerland : trends and social inequalities

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Abstract
Background: Cervical cancer screening (CCS) by means of Pap smears has led to a decrease in cervical cancer incidence and mortality. In the absence of organized programmes, CCS is opportunistic in Belgium and Switzerland. This might result in a high level of CCS overuse, as screening practices do not conform to the recommended 3-yearly screening interval and the target age-ranges (Belgium: 25–64, Switzerland: 20–70). This study aimed to assess trends in CCS uptake and overuse in Belgium and Switzerland and their social determinants, in the light of reimbursement initiatives, which were implemented in both countries. Methods: Data from five waves of the Belgian Health Interview Survey (1997–2013) (N=11 141) and Swiss Health Interview Survey (1992–2012) (N=32 696) were used. We performed Poisson regressions to estimate adjusted prevalence ratios (APR), controlled for socio-economic and socio-demographic characteristics and health status. CCS overuse was operationalized as screening more than once every 3 years and screening above recommended age-range. Results: CCS uptake remained relatively stable over time, with a mean coverage of 70.9% in Belgium and 73.1% in Switzerland. Educational and income gradients were found in both countries. Concerning CCS overuse, women above screening-eligible age showed consistently high screening rates, but screening within the past year declined significantly in both countries, matching the temporal implementation of the reimbursement initiatives. Conclusions: Although no increase in CCS coverage could be established, CCS has become more efficient in both countries as Pap smear overuse at the population level has declined after the implementation of reimbursement measures tackling CCS overuse.
Keywords
Public Health, Environmental and Occupational Health, QUALITY-ASSURANCE, UNITED-STATES, WOMEN, GUIDELINES, PATIENT, EUROPE, BREAST, INTERVENTIONS, MORTALITY, PATTERNS, cervical cancer, Belgium, demography, income, reimbursement mechanisms, socioeconomic factors, vaginal smears, knowledge acquisition, cervical cancer screening, wave - physical agent

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MLA
De Prez, Vincent, et al. “Cervical Cancer (over)Screening in Belgium and Switzerland : Trends and Social Inequalities.” EUROPEAN JOURNAL OF PUBLIC HEALTH, vol. 30, no. 3, 2020, pp. 410–15, doi:10.1093/eurpub/ckaa041.
APA
De Prez, V., Jolidon, V., Willems, B., Cullati, S., Burton-Jeangros, C., & Bracke, P. (2020). Cervical cancer (over)screening in Belgium and Switzerland : trends and social inequalities. EUROPEAN JOURNAL OF PUBLIC HEALTH, 30(3), 410–415. https://doi.org/10.1093/eurpub/ckaa041
Chicago author-date
De Prez, Vincent, Vladimir Jolidon, Barbara Willems, Stéphane Cullati, Claudine Burton-Jeangros, and Piet Bracke. 2020. “Cervical Cancer (over)Screening in Belgium and Switzerland : Trends and Social Inequalities.” EUROPEAN JOURNAL OF PUBLIC HEALTH 30 (3): 410–15. https://doi.org/10.1093/eurpub/ckaa041.
Chicago author-date (all authors)
De Prez, Vincent, Vladimir Jolidon, Barbara Willems, Stéphane Cullati, Claudine Burton-Jeangros, and Piet Bracke. 2020. “Cervical Cancer (over)Screening in Belgium and Switzerland : Trends and Social Inequalities.” EUROPEAN JOURNAL OF PUBLIC HEALTH 30 (3): 410–415. doi:10.1093/eurpub/ckaa041.
Vancouver
1.
De Prez V, Jolidon V, Willems B, Cullati S, Burton-Jeangros C, Bracke P. Cervical cancer (over)screening in Belgium and Switzerland : trends and social inequalities. EUROPEAN JOURNAL OF PUBLIC HEALTH. 2020;30(3):410–5.
IEEE
[1]
V. De Prez, V. Jolidon, B. Willems, S. Cullati, C. Burton-Jeangros, and P. Bracke, “Cervical cancer (over)screening in Belgium and Switzerland : trends and social inequalities,” EUROPEAN JOURNAL OF PUBLIC HEALTH, vol. 30, no. 3, pp. 410–415, 2020.
@article{8665241,
  abstract     = {Background: Cervical cancer screening (CCS) by means of Pap smears has led to a decrease in cervical cancer incidence and mortality. In the absence of organized programmes, CCS is opportunistic in Belgium and Switzerland. This might result in a high level of CCS overuse, as screening practices do not conform to the recommended 3-yearly screening interval and the target age-ranges (Belgium: 25–64, Switzerland: 20–70). This study aimed to assess trends in CCS uptake and overuse in Belgium and Switzerland and their social determinants, in the light of reimbursement initiatives, which were implemented in both countries.

Methods: Data from five waves of the Belgian Health Interview Survey (1997–2013) (N=11 141) and Swiss Health Interview Survey (1992–2012) (N=32 696) were used. We performed Poisson regressions to estimate adjusted prevalence ratios (APR), controlled for socio-economic and socio-demographic characteristics and health status. CCS overuse was operationalized as screening more than once every 3 years and screening above recommended age-range.

Results: CCS uptake remained relatively stable over time, with a mean coverage of 70.9% in Belgium and 73.1% in Switzerland. Educational and income gradients were found in both countries. Concerning CCS overuse, women above screening-eligible age showed consistently high screening rates, but screening within the past year declined significantly in both countries, matching the temporal implementation of the reimbursement initiatives.

Conclusions: Although no increase in CCS coverage could be established, CCS has become more efficient in both countries as Pap smear overuse at the population level has declined after the implementation of reimbursement measures tackling CCS overuse.},
  author       = {De Prez, Vincent and Jolidon, Vladimir and Willems, Barbara and Cullati, Stéphane and Burton-Jeangros, Claudine and Bracke, Piet},
  issn         = {1101-1262},
  journal      = {EUROPEAN JOURNAL OF PUBLIC HEALTH},
  keywords     = {Public Health,Environmental and Occupational Health,QUALITY-ASSURANCE,UNITED-STATES,WOMEN,GUIDELINES,PATIENT,EUROPE,BREAST,INTERVENTIONS,MORTALITY,PATTERNS,cervical cancer,Belgium,demography,income,reimbursement mechanisms,socioeconomic factors,vaginal smears,knowledge acquisition,cervical cancer screening,wave - physical agent},
  language     = {eng},
  number       = {3},
  pages        = {410--415},
  title        = {Cervical cancer (over)screening in Belgium and Switzerland : trends and social inequalities},
  url          = {http://dx.doi.org/10.1093/eurpub/ckaa041},
  volume       = {30},
  year         = {2020},
}

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