Study finds lack of cervical screening in non-Caucasian, young and socioeconomically deprived women

Cervical cancer is the second most frequently found malignancy world-wide in women, with approximately 250,000 deaths and 400,000 new cases a year. In 2008, 54,800 new cervical cancer cases were reported in Europe, with 25,000 resulting in death. The United Kingdom accounted for 2,500 of these new cases and 830 deaths.

New research published today in the Journal of Public Health has found that cervical screening participation is significantly lower in general practices that look after a high percentage of younger-aged women, non-Caucasian women and those living in areas of socioeconomic deprivation. The authors, Ji Young Bang, Ghasem Yadegarfar, Michael Soljak and Azeem Majeed, suggest that this disparity needs to be addressed by developing and implementing strategies to improve cervical screening attendance in these women.

In order to identify the socioeconomic and general practice factors associated with cervical screening in England, the authors performed a national cross-sectional study using data on 26,497,476 women registered with 7,970 practices in 152 English Primary Care Trusts (PCT). Data from the Quality and Outcomes Framework (QOF), a system in England that enables participating general practices to be monitored in their achievements, provided information on staffing levels, socioeconomic status and QOF Indicators between 2008 and 2009. Bang, Yadegarfar, Soljak and Majeed also calculated the number of female patients per full-time general practitioner, in a population of 100,000, using data from 2007 Information Centre for Health & Social Care Database. The Index of Multiple Deprivation (IMD) score, which calculates the degrees of socioeconomic deprivation based on housing, employment, health, education, crime, and income, was taken from the 2004 Department of Communities and Local Government (DCLG) IMD database. The estimated number of patients of different ethnicities and the proportion of female patients aged 25-49 and 50-64 that were registered with practices as of April 2008 were also included in the analysis.     

The main findings of the study showed that on regression analysis, socioeconomic factors such as the proportion of female patients aged 25-49 years, the percentage of ethnic minority patients and the IMD score,  were all associated negatively with cervical screening in both PCTs and practices. On the other hand, the percentage of female patients aged 50-64 years, the overall QOF score and the records/information score were significantly positively associated with cervical screening coverage but only at practice level. Also, at a PCT level, cervical screening coverage ranged from 65.8% to 85.8% and at a practice level, cervical screening ranged from 0 to 100% with a mean and median of 83.5%.  This presents quite a difference between practices. The results found in 'Primary care factors associated with cervical screening coverage in England', published today in the Journal of Public Health, identifies the groups of women in which cervical attendance should be vastly improved and builds on a body of research that has also identified a lack of screening in non-Caucasian, young and socioeconomically deprived women. Previous research has acknowledged that non-Caucasian women do have a lower attendance for cervical screening and it has been suggested that the reason for this is due to a lack of knowledge regarding the cervical screening programme. 

Ji Young Bang suggests that "to improve cervical screening, a system for educating these individuals and improving knowledge of the service provided needs to be instituted. More organised practices may be better at monitoring and delivering health care to the local population, resulting in the implementation of policies that can deliver positive results in increasing cervical screening.  To improve cervical screening a multifaceted approach is needed that includes patients, physicians, individual practices and policy makers."

"Performance indicators, such as cervical screening coverage, can be substantially influenced by population factors such as age, ethnicity, and socioeconomic status.  Using crude performance data to determine the quality of care provided by general practices and PCTs can be misleading. This is an important issue as the UK government has announced this year that the general practice performance data will be made available publicly in the near future."

Bang concludes that "our study illustrates that population and health system characteristics remain important influences on participation in preventative interventions such as cervical screening, even in a health system that offers free of charge access to universal healthcare. Also, in the 21st century, more than twenty years after the start of cervical screening in England, socioeconomic, ethnic and age-related disparities still exist. To improve cervical screening in England, efforts should focus on implementing and developing strategies for improving cervical screening attendance in the young, socioeconomically disadvantaged and ethnic minority women."